Miss Janice Baxter DDS

 
 Notice: This is NOT a bill. Do not pay. If it is 
 determined that this service or a portion of 
 these services is not payable by your health 
 THIBODAUX REGIONAL 
 plan, you will be responsible. 
 HEALTH SYSTEM 
 P O BOX 1638 
 THIBODAUX, LA 70632-1638 
 PLEASE CHANGE ADDRESS IF INCORRECT 
 T2 P1 
 Miss Janice Baxter DDS
 126 JACOBS ST 
 554 
 NAPOLEONVILLE LA 70363-2639 
 ACCOUNT SUMMARY 
 Guarantor Number: 
 GN08402365 
 Account Number: 
 V00084023651 
 Name: Buggage,Nadine 
 Bill Date: 
 06/26/22 
 Service Dates: 
 15 Sep 2021-06/22/22 
 Insurance Policy Number 
 Insurance Coverage 
 IHQ862884023652 
 Blue Cross Louisiana 
 For additional information, please contact us at 845-347-8715.
 
