Sandra Obrien

 
 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 1468 
 THIBODAUX, LA 70462-1468 
 PLEASE CHANGE ADDRESS IF INCORRECT 
 T2 P1 
 Sandra Obrien
 126 JACOBS ST 
 554 
 NAPOLEONVILLE LA 70346-2469 
 ACCOUNT SUMMARY 
 Guarantor Number: 
 GN09046120 
 Account Number: 
 V00090461201 
 Name: Buggage,Nadine 
 Bill Date: 
 06/26/22 
 Service Dates: 
 10/03/2018-06/22/22 
 Insurance Policy Number 
 Insurance Coverage 
 IHQ862890461202 
 Blue Cross Louisiana 
 For additional information, please contact us at 128-849-6378.
 
