Provider Demographics
NPI:1215621073
Name:IMPERIAL DIAGNOSTICS LLC
Entity type:Organization
Organization Name:IMPERIAL DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:OQUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-757-3617
Mailing Address - Street 1:2640 E LEAGUE CITY PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3369
Mailing Address - Country:US
Mailing Address - Phone:601-757-3617
Mailing Address - Fax:
Practice Address - Street 1:2640 E LEAGUE CITY PKWY STE 104
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3369
Practice Address - Country:US
Practice Address - Phone:601-757-3617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty