Healthcare Provider Details

I. General information

NPI: 1033157441
Provider Name (Legal Business Name): IMG PHYSICIANS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 STARBRUSH CIR
COVINGTON LA
70433-7208
US

IV. Provider business mailing address

1375 CORPORATE SQUARE DR
SLIDELL LA
70458-3147
US

V. Phone/Fax

Practice location:
  • Phone: 337-408-0797
  • Fax: 985-871-0529
Mailing address:
  • Phone: 337-408-0797
  • Fax: 985-643-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE ROMERO
Title or Position: REVENUE TEAM LEAD
Credential:
Phone: 337-408-0797