Provider Demographics
NPI:1841668654
Name:IMPERIUM HEALTH RESOURCES, LLC
Entity type:Organization
Organization Name:IMPERIUM HEALTH RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-593-6262
Mailing Address - Street 1:8821 DAVIS BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248
Mailing Address - Country:US
Mailing Address - Phone:682-593-6262
Mailing Address - Fax:877-576-4230
Practice Address - Street 1:8821 DAVIS BLVD
Practice Address - Street 2:STE 100
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248
Practice Address - Country:US
Practice Address - Phone:281-806-9544
Practice Address - Fax:877-576-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2094568OtherCLIA