MEDICARE: IMPERIAL HEALTH LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1710235767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL HEALTH LLP

Provider Business Mailing Address
First Line	:	501 DR MICHAEL DEBAKEY DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5724
Country	:	US
Telephone Number	:	337-433-8400
Fax Number	:	337-312-6708

Provider Business Practice Location Address
First Line	:	711 DR MICHAEL DEBAKEY DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5785
Country	:	US
Telephone Number	:	337-493-2200
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. KEITH D BROACH
Credential	:
Telephone Number	:	337-990-5510

Provider Enumeration Date	:	08/23/2012
Last Update Date	:	04/30/2014

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Directions to “IMPERIAL HEALTH LLP ” Practice Location

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