TECHE ACTION BOARD, INC. (NPI# 1356767420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1356767420 |
Entity Type | Organization |
Organization Name | TECHE ACTION BOARD, INC. |
Other Organization Name | TECHE ACTION CLINIC @ THIBODAUX |
Practice Address |
1709 Ridgefield Rd Thibodaux LA 70301-4333 |
Mailing Address |
1115 Weber St Franklin LA 70538-4124 |
Practice Telephone | 3378282550 |
Practice Fax Number | 3373552335 |
Mailing Telephone | 3378282550 |
Mailing Fax Number | 3373552335 |
Enumeration Date | 2014-03-12 |
Last Update Date | 2016-07-20 |
Authorized Official Name | DR. GARY M WILTZ (CEO) |
Authorized Official Telephone | 3378282550 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
LA | MEDICARE PART B | 5B803 | 01 |
LA | 2381954 | 05 |
Other Name | Type Code |
---|---|
Teche Action Clinic @ Thibodaux | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912354176 | Teche Action Board, Inc. | Clinic/Center | 2555 La Hwy 18, Edgard, LA 70049-2417 | 2016-05-18 |
1215354014 | Teche Action Board, Inc. | Clinic/Center | 121 West 134th Place, Galliano, LA 70354 | 2014-03-19 |
1902082811 | Teche Action Board, Inc. | Clinic/Center | 18331 Highway 182, Baldwin, LA 70514-1449 | 2008-01-10 |
1154368553 | Teche Action Board, Inc. | Clinic/Center | 159 E 3rd St, Edgard, LA 70049-2450 | 2006-06-02 |
1215974019 | Teche Action Board, Inc. | Clinic/Center | 1014 West Tunnel Blvd, Houma, LA 70360-5555 | 2006-06-01 |
1760016562 | Teche Action Board, Inc. | Pharmacist | 1124 7th St, Morgan City, LA 70380 | 2020-03-02 |
1639702087 | Teche Action Board, Inc. | Pharmacy | 1124 7th St, Morgan City, LA 70380-1951 | 2020-02-13 |
1801433883 | Teche Action Board, Inc. | Clinic/Center | 827 N Pine St, Gramercy, LA 70052-3602 | 2019-12-09 |
1255788428 | Teche Action Board, Inc. | Clinic/Center | 1 Wildcat Dr, Reserve, LA 70084-5800 | 2016-05-18 |
1477900637 | Teche Action Board, Inc. | Clinic/Center | 393 Greenwood Dr, La Place, LA 70068-2535 | 2016-05-18 |
Street Address |
1709 RIDGEFIELD RD |
City | THIBODAUX |
State | LA |
Zip Code | 70301-4333 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184904773 | Rhonda Lombas | Nurse Practitioner | 1709 Ridgefield Rd, Thibodaux, LA 70301-4333 | 2011-08-26 |
1588278246 | Caroline Elizabeth Ayers | Physician Assistant | 1709 Ridgefield Rd, Thibodaux, LA 70301-4333 | 2020-09-01 |
1538596739 | Rebecca M Breaux | Nurse Practitioner | 1709 Ridgefield Rd, Thibodaux, LA 70301-4333 | 2013-10-02 |
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 Code | 261QF0400X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Federally Qualified Health Center (FQHC) |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1285114223 | Access Health Louisiana | Clinic/Center | 802 E 7th St, Thibodaux, LA 70301-3607 | 2018-08-20 |
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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.