NICHOLLS STATE UNIVERSITY


Address: 906 E 1st St, Thibodaux, LA 70301-6701
Phone: 9854484837

NICHOLLS STATE UNIVERSITY (NPI# 1861881435) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1861881435
Entity Type Organization
Organization Name NICHOLLS STATE UNIVERSITY
Other Organization Name NICHOLLS STATE SPORTS MEDICINE
Practice Address 906 E 1st St
Thibodaux
LA 70301-6701
Mailing Address 5050 Spring Valley Rd
Dallas
TX 75244-3995
Practice Telephone 9854484837
Practice Fax Number 9723673451
Mailing Telephone 8005559073
Mailing Fax Number 9723673452
Enumeration Date 2015-01-20
Last Update Date 2015-01-20
Authorized Official Name MOUZON BASS III (AGENT)
Authorized Official Telephone 18005559073
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207QS0010X Family Medicine
Specialization: Sports Medicine
Allopathic & Osteopathic Physicians
Y 207Q00000X Family Medicine Allopathic & Osteopathic Physicians

Other Provider/Organization Names

Other Name Type Code
Nicholls state sports medicine Doing Business As Name - Organization

Other Data Sources

Entity Type Entity Name Entity Address
System for Award Management (SAM) Entities NICHOLLS STATE UNIVERSITY 906 E 1st St, Thibodaux, LA 70301-6701

Office Location

Street Address 906 E 1ST ST
City THIBODAUX
State LA
Zip Code 70301-6701

Providers in the same location

NPI Name Taxonomy Address Enumeration
1295227635 The Foundation for The Advancement of A Strategic Science of Teaching Behavioral Analyst 906 E 1st St, Thibodaux, LA 70301-6701 2018-06-01
1700374220 Braden Patrick Jarrard Specialist/Technologist 906 E 1st St, Thibodaux, LA 70301-6701 2018-04-30
1629577655 Travis James Rousselle Specialist/Technologist 906 E 1st St, Thibodaux, LA 70301-6701 2018-02-05
1154859171 Maureen Brooks Specialist/Technologist 906 E 1st St, Thibodaux, LA 70301-6701 2017-06-03
1821532888 Cheyenne Naquin Specialist/Technologist 906 E 1st St, Thibodaux, LA 70301-6701 2016-12-11
1154865129 Holden Melerine Student in an Organized Health Care Education/Training Program 906 E 1st St, Thibodaux, LA 70301-6701 2016-12-11
1841734811 Jordan Lee Hartman Student in an Organized Health Care Education/Training Program 906 E 1st St, Thibodaux, LA 70301-6701 2016-12-11
1861935520 Kaelin Brett Scivicque Student in an Organized Health Care Education/Training Program 906 E 1st St, Thibodaux, LA 70301-6701 2016-11-29
1386187136 Destiny Rose Fitch Student in an Organized Health Care Education/Training Program 906 E 1st St, Thibodaux, LA 70301-6701 2016-11-28
1487001970 Timothy Quinton Nease II Specialist/Technologist 906 E 1st St, Sports Medicine-basketball, Thibodaux, LA 70301-6701 2016-05-16
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1225539620 Micah Aaron Callais Nurse Practitioner 604 N. Acadia Road, Suite 200, Thibodaux, LA 70301 2018-02-22
1982112348 Katie Leblanc Massage Therapist 1115 St. Mary Street, Thibodaux, LA 70301 2018-01-18
1154837391 Texas Digestive Disease Consultants, Pllc Internal Medicine 764 North Acadia Road, Suite A, Thibodaux, LA 70301 2017-12-26
1235648239 Speech and Feeding Therapy, LLC Speech-Language Pathologist 1000 Plantation Rd Ste 1a, Thibodaux, LA 70301 2017-09-22
1285150466 Tara Payne Counselor 303 Hickory Street, Thibodaux, LA 70301 2017-08-18
1427583475 Tyler Pettigrew Counselor 300 Plantation Rd., Apt #24, Thibodaux, LA 70301 2017-04-27
1750825758 Jessica Barquet Counselor 110 Palm Villa Dr Apt 1, Thibodaux, LA 70301 2016-12-09
1013468230 Shenee Haas Gros Counselor 504 Cherry St., Thibodaux, LA 70301 2016-10-24
1982155388 Southern Ent Associates Inc Audiologist 604 North Acadia Road Suite 101, Thibodaux, LA 70301 2016-10-20
1215483888 Lesheeca Norman, Lpc Counselor 306 Victoria Court, Thibodaux, LA 70301 2016-09-01
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Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1871792051 Adrienne C Robertson Family Medicine 1001 Jackson St, Thibodaux, LA 70301-3227 2007-07-17
1760692081 Alan B. Fortier Jr. Family Medicine 804 S Acadia Rd, Thibodaux, LA 70301-4850 2007-05-23
1518085679 Sayes Family Medical Corporation Apmc Family Medicine 206 E 2nd St, Thibodaux, LA 70301-3306 2007-03-27
1891878427 James B Hyatt Family Medicine 1101 Audubon Ave Ste S1, Thibodaux, LA 70301-4957 2006-10-24
1083727838 Raja Talluri Md A Professional Family Medicine 1214 Cardinal Dr, Thibodaux, LA 70301-4815 2006-08-16
1881611820 Anna Marie Falcon Family Medicine 210 Ardoyne Avenue, Thibodaux, LA 70301 2006-07-16
1972529402 Billy Wray Hillman Jr. Family Medicine 426 Highway 308, Thibodaux, LA 70301-5752 2006-07-15
1396738670 John Wesley Magee IIi Family Medicine 804 South Acadia Road, Thibodaux, LA 70301 2005-08-23
1770903205 Brandon Michael Gil Family Medicine 602 N Acadia Rd, Thibodaux, LA 70301 2014-04-23
1710244041 Joshua Jesus Huval Family Medicine 804 S Acadia Rd, Thibodaux, LA 70301-4850 2012-04-11
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Competitor

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City THIBODAUX
Zip Code 70301

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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