Healthcare Provider Details

I. General information

NPI: 1780256602
Provider Name (Legal Business Name): IMPERIAL HEALTH LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SOUTHWOOD DRIVE
LAKE CHARLES LA
70605
US

IV. Provider business mailing address

501 DR. MICHAEL DE BAKEY DRIVE
LAKE CHARLES LA
70601-5724
US

V. Phone/Fax

Practice location:
  • Phone: 337-474-2856
  • Fax: 337-480-0645
Mailing address:
  • Phone: 337-312-8420
  • 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: TONYA C RICHARD
Title or Position: CHIEF OPERATING OFFICER
Credential: COO
Phone: 337-312-8291