Provider Demographics
NPI:1255994125
Name:IMPERIAL HEALTH, LLP
Entity type:Organization
Organization Name:IMPERIAL HEALTH, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:337-312-8291
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:337-312-8420
Mailing Address - Fax:337-312-6708
Practice Address - Street 1:1327 STELLY LANE
Practice Address - Street 2:SUITE 3
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663
Practice Address - Country:US
Practice Address - Phone:337-310-3670
Practice Address - Fax:337-421-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty