=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730401969
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMPERIAL HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2010
-----------------------------------------------------
Last Update Date | 02/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 W COLE BLVD STE A
-----------------------------------------------------
City | CALEXICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92231-9700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-357-1385
-----------------------------------------------------
Fax | 760-357-9507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 W COLE BLVD STE A
-----------------------------------------------------
City | CALEXICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92231-9700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-357-1385
-----------------------------------------------------
Fax | 760-357-9507
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. MELVIN LEWIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 760-357-1385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | A51248
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------