Provider Demographics
NPI:1578624433
Name:INTERNAL MEDICINE CONSULTANTS PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:402-426-2210
Mailing Address - Street 1:407 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1907
Mailing Address - Country:US
Mailing Address - Phone:402-426-2210
Mailing Address - Fax:402-426-2235
Practice Address - Street 1:407 S 19TH ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1907
Practice Address - Country:US
Practice Address - Phone:402-426-2210
Practice Address - Fax:402-426-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025285200Medicaid
NE10025285200Medicaid