=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578624433
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERNAL MEDICINE CONSULTANTS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 08/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 S 19TH ST
-----------------------------------------------------
City | BLAIR
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68008-1907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-426-2210
-----------------------------------------------------
Fax | 402-426-2235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 407 S 19TH ST
-----------------------------------------------------
City | BLAIR
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68008-1907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-426-2210
-----------------------------------------------------
Fax | 402-426-2235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING OFFICE
-----------------------------------------------------
Name | MS. SUSIE M LEONARD
-----------------------------------------------------
Credential | CMA
-----------------------------------------------------
Telephone | 402-426-2210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------