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General NPI Number Information
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NPI Number | 1881942837
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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 | 08/23/2012
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 1747 IMPERIAL BLVD STE B
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City | LAKE CHARLES
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State | LA
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Zip | 70605-5362
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Country | US
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Telephone | 337-433-8400
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Fax |
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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 | ASST. ADMINISTRATOR
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Name | MS. TONYA RICHARD
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Credential |
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Telephone | 337-433-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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