Provider Demographics
NPI:1659717262
Name:INDEPENDENT MEDICAL CONSULTANTS, LLC
Entity Type:Organization
Organization Name:INDEPENDENT MEDICAL CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LEINENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-226-0118
Mailing Address - Street 1:2913 SW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4868
Mailing Address - Country:US
Mailing Address - Phone:971-226-0118
Mailing Address - Fax:360-369-4932
Practice Address - Street 1:2913 SW 7TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4868
Practice Address - Country:US
Practice Address - Phone:971-226-0118
Practice Address - Fax:360-369-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD153000202C00000X, 207R00000X, 208D00000X
WAMD60348035202C00000X, 207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500643083Medicaid