1922080308 NPI number — LOUIS THIBODEAUX M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922080308 NPI number — LOUIS THIBODEAUX M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

THIBODEAUX

Provider First Name:

LOUIS

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1922080308

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/08/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

11155 KENWOOD RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CINCINNATI

Provider Business Mailing Address State Name:

OH

Provider Business Mailing Address Postal Code:

45242-1817

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

513-385-1919

Provider Business Mailing Address Fax Number:

513-385-6208

Provider First Line Business Practice Location Address:

11155 KENWOOD RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CINCINNATI

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

45242-1817

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

513-385-1919

Provider Business Practice Location Address Fax Number:

513-385-6208

Provider Enumeration Date:

11/18/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208600000X , with the licence number:  35063926 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2086S0129X , with the licence number: 35063926 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 0943242 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 310837421SA . This is a "EMERALD HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000007820 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 100328970A , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 64958879 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 14096 . This is a "NATIONWIDE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 310837421027 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 1701181 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 9246433001 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0972646 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 310837421 . This is a "WAUSAU" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".