Healthcare Provider Details

I. General information

NPI: 1184972127
Provider Name (Legal Business Name): IMPERIAL HEALTH, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 DR MICHAEL DEBAKEY DR STE 110
LAKE CHARLES LA
70601-5889
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 337-419-1947
  • Fax:
Mailing address:
  • Phone: 337-433-8400
  • Fax: 337-312-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY GILBERT
Title or Position: EXECUTIVE CHAIRMAN
Credential: M.D.
Phone: 337-310-6970