MEDICARE: INDEPENDENT HEALTHCARE MANAGEMENT, INC.

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	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255376729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT HEALTHCARE MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	PO BOX D
Second Line	:
City	:	FOREST
State	:	MS
Zip	:	39074-0558
Country	:	US
Telephone Number	:	601-469-4151
Fax Number	:	601-469-9927

Provider Business Practice Location Address
First Line	:	505 AIRPORT RD STE B
Second Line	:
City	:	FOREST
State	:	MS
Zip	:	39074-4033
Country	:	US
Telephone Number	:	601-469-4771
Fax Number	:	601-469-4724

Authorized Official
Title or Position	:	CHAIRMAN OF THE BOARD
Name	:	JOHN P LEE
Credential	:
Telephone Number	:	601-469-4151

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	07/17/2023

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