Healthcare Provider Details

I. General information

NPI: 1780334490
Provider Name (Legal Business Name): IMPERIAL HEALTH LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5726
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 337-312-6010
  • Fax: 337-312-6011
Mailing address:
  • Phone: 337-312-8528
  • Fax:

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: NIKKI LYN DUGAS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 337-312-8528