MEDICARE: INDEPENDENT COMPLIANCE CONSULTANTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1104752831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT COMPLIANCE CONSULTANTS LLC

Provider Business Mailing Address
First Line	:	2808 COLE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2808 COLE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-1030
Country	:	US
Telephone Number	:	855-340-0838
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ALEXANDER PETERS
Credential	:
Telephone Number	:	206-963-8359

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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