Healthcare Provider Details

I. General information

NPI: 1952326241
Provider Name (Legal Business Name): INDEPENDENT HEALTHCARE MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N BROAD ST
FOREST MS
39074-3508
US

IV. Provider business mailing address

PO BOX 1100
MAGEE MS
39111-1100
US

V. Phone/Fax

Practice location:
  • Phone: 601-469-4151
  • Fax: 601-469-3681
Mailing address:
  • Phone: 601-849-6440
  • Fax: 601-849-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number13-033
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: JOHN P LEE
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 601-849-6440