# IMPERIAL HEALTH LLP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053929166
- **Authorized official:** NIKKI LYN DUGAS (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (337) 312-8528

## Contact information

- **Practice address:** 200 W 5TH ST, DERIDDER, LA 70634-4856
- **Practice address phone:** (337) 202-7850
- **Mailing address:** 501 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5724

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/15/2020
- **Last updated:** 07/15/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1016314 | — | LA |