Provider Demographics
NPI:1801207436
Name:IMPERIAL HEALTH LLP
Entity Type:Organization
Organization Name:IMPERIAL HEALTH LLP
Other - Org Name:VEIN CENTER OF SOUTHWEST LOUISIANA
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-990-5510
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:337-433-8400
Mailing Address - Fax:337-312-6708
Practice Address - Street 1:1700 KALISTE SALOOM RD
Practice Address - Street 2:BLDG 2, STE 201
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6112
Practice Address - Country:US
Practice Address - Phone:337-534-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty