Healthcare Provider Details

I. General information

NPI: 1316557986
Provider Name (Legal Business Name): INDEPENDENT HEALTHCARE MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 SIMPSON HIGHWAY 149 STE 300
MAGEE MS
39111-3569
US

IV. Provider business mailing address

PO BOX D
FOREST MS
39074-0558
US

V. Phone/Fax

Practice location:
  • Phone: 601-849-6440
  • Fax: 601-849-1332
Mailing address:
  • Phone: 601-469-4151
  • Fax: 601-469-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN P LEE
Title or Position: CHAIRMAN OF THE BOARD
Credential: MD
Phone: 601-469-4151