Provider Demographics
NPI:1417365495
Name:IMPERIAL HEALTH-CARDIOVASCULAR SPECIALISTS OF SWLA
Entity Type:Organization
Organization Name:IMPERIAL HEALTH-CARDIOVASCULAR SPECIALISTS OF SWLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-312-8472
Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5727
Practice Address - Country:US
Practice Address - Phone:337-436-3813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07952261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care