Provider Demographics
NPI:1528835311
Name:INDEPENDENT BILLING SERVICE LLC
Entity type:Organization
Organization Name:INDEPENDENT BILLING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEYMIAN
Authorized Official - Middle Name:LEVANTE
Authorized Official - Last Name:CRISP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-933-1204
Mailing Address - Street 1:405 MAPLE AVE
Mailing Address - Street 2:401
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5139
Mailing Address - Country:US
Mailing Address - Phone:133-653-9379
Mailing Address - Fax:
Practice Address - Street 1:401 MAPLE AVE
Practice Address - Street 2:# 401
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5139
Practice Address - Country:US
Practice Address - Phone:336-539-3796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty