Provider Demographics
NPI:1467863837
Name:IMPERIUM CONSULTING, LLC
Entity Type:Organization
Organization Name:IMPERIUM CONSULTING, LLC
Other - Org Name:ABILENE PAIN ASSESSMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-721-9427
Mailing Address - Street 1:17300 DALLAS PKWY
Mailing Address - Street 2:1080A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1145
Mailing Address - Country:US
Mailing Address - Phone:832-721-9427
Mailing Address - Fax:
Practice Address - Street 1:1665 ANTILLEY RD
Practice Address - Street 2:240
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5265
Practice Address - Country:US
Practice Address - Phone:832-721-9427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SN0800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeuroscienceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid
TX=========Medicaid