Organization
IMPERIAL HEALTH LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIKKI LYN DUGAS (CREDENTIALING COORDINATOR)
(337) 312-8528
Entity
Organization
Contact information
Practice address
200 W 5TH ST, DERIDDER, LA 70634-4856
(337) 202-7850
Mailing address
501 DR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5724
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016314
—
LA
Enumeration date
07/15/2020
Last updated
07/15/2020
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