Healthcare Provider Details

I. General information

NPI: 1659717262
Provider Name (Legal Business Name): INDEPENDENT MEDICAL CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 SW 7TH AVE
BATTLE GROUND WA
98604-4868
US

IV. Provider business mailing address

2913 SW 7TH AVE
BATTLE GROUND WA
98604-4868
US

V. Phone/Fax

Practice location:
  • Phone: 971-226-0118
  • Fax: 360-369-4932
Mailing address:
  • Phone: 971-226-0118
  • Fax: 360-369-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60348035
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD153000
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD153000
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD60348035
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberMD153000
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberMD60348035
License Number StateWA

VIII. Authorized Official

Name: DR. DEREK JAMES LEINENBACH
Title or Position: OWNER
Credential: M.D.
Phone: 971-226-0118