| Organization Name: | ABUNDANT HEALTH MEDICAL CLINIC, LLC |
| NPI Number: | 1003288614 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ADRIENNE CHANELLE ROBERTSON (MEDICAL DIRECTOR) |
| Mailing Address: | 1001 Jackson St Thibodaux |
| State: | LA US |
| Postal Code: | 703013227 |
| Phone Number: | 9854929111 |
| Fax Number: | 9854929114 |
| NPI Enumeration Date: | 10/22/2015 |
| NPI Last Update Date: | 10/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Medical Specialty |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |