Healthcare Provider Details

I. General information

NPI: 1710578158
Provider Name (Legal Business Name): IMPERIAL HEALTH, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 STELLY LANE SUITE 2
SULPHUR LA
70663
US

IV. Provider business mailing address

501 DR. MICHAEL DEBAKEY DRIVE
LAKE CHARLES LA
70601
US

V. Phone/Fax

Practice location:
  • Phone: 337-310-3670
  • Fax: 337-421-1408
Mailing address:
  • Phone: 337-312-8360
  • Fax: 337-312-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TONYA RICHARD
Title or Position: CHIEF OPERATING OFFICER
Credential: CMPE
Phone: 337-312-8291