Healthcare Provider Details

I. General information

NPI: 1487296588
Provider Name (Legal Business Name): IMPERIAL HEALTH LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 5TH STREET
DERIDDER LA
70634
US

IV. Provider business mailing address

501 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5724
US

V. Phone/Fax

Practice location:
  • Phone: 337-436-3813
  • Fax: 337-439-0214
Mailing address:
  • Phone: 337-312-8420
  • Fax: 337-312-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TONYA RICHARD
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 337-312-8291