| Organization Name: | THIBODAUX LASER AND SURGERY CENTER, LLC |
| NPI Number: | 1073505616 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | QUENTIN D. FALGOUST (MANAGER) |
| Mailing Address: | 1101 Audubon Ave Suite S4 Thibodaux |
| State: | LA US |
| Postal Code: | 703014957 |
| Phone Number: | 9854477246 |
| Fax Number: | 9854467614 |
| NPI Enumeration Date: | 08/19/2005 |
| NPI Last Update Date: | 03/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 107 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |