Provider Demographics
NPI:1881714707
Name:IMPERIAL CENTER FAMILY MEDICINE AND IMMEDIATE CARE PLLC
Entity type:Organization
Organization Name:IMPERIAL CENTER FAMILY MEDICINE AND IMMEDIATE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT REPRESENTATIVE/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-941-0158
Mailing Address - Street 1:4309 EMPEROR BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8045
Mailing Address - Country:US
Mailing Address - Phone:919-941-0158
Mailing Address - Fax:919-474-3130
Practice Address - Street 1:4309 EMPEROR BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8045
Practice Address - Country:US
Practice Address - Phone:919-941-0158
Practice Address - Fax:919-474-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty