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General NPI Number Information
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NPI Number | 1144577719
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Entity Type | Organization
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Legal Business Name | IMPERIAL HEALTH, LLP
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 122 W 4TH ST
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City | DEQUINCY
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State | LA
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Zip | 70633-3508
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Country | US
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Telephone | 337-401-4920
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Fax | 337-313-4237
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Provider Business Mailing Address
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Address Line | 501 DR MICHAEL DEBAKEY DR
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5724
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Country | US
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Telephone | 337-433-8400
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Fax | 337-312-6708
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Authorized Official
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Title or Position | ASSISTANT ADMINISTRATOR
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Name | TONYA RICHARD
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Credential |
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Telephone | 337-312-8291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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