Imperial Medicine LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

303623 Issued in LA

Legal business name

IMPERIAL MEDICINE LLC

Practice address

1800 Irving PL
Shreveport, LA 71101-4608

Phone

(318) 425-4096

Fax

(318) 425-8438

NPI assigned

May 3, 2017

Last updated

May 3, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Deanna Mossallati, DO

Title

Member Manager

Phone

(318) 425-4096

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeremy Mendez, CRNA

  • Certified Registered Nurse Anesthetist
  • Plantation, FL
  • NPI 1194137562
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493769600000",
    "number": "1629504220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64568",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850824568",
            "telephone_number": "318-424-5449",
            "fax_number": "855-230-1466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 IRVING PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014608",
            "telephone_number": "318-425-4096",
            "fax_number": "318-425-8438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPERIAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-03",
        "last_updated": "2017-05-03",
        "status": "A",
        "authorized_official_last_name": "MOSSALLATI",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "318-425-4096",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "303623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jazeb Ifikhar
• Patrick Igbokwe, PHARMD
• Ihab John Ibrahim MD LLC
• Priscilla Ihenacho, MD
• Impact Transit Service
• Angela Impson, LOTR
• Madeline Imster
• Daniya Imthias
• Rabel Gul Imtiaz
• In Between PCP and Med-Spa Inc (NA)

• Internal Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.