Healthcare Provider Details

I. General information

NPI: 1952694994
Provider Name (Legal Business Name): INDEPENDENT HEALTHCARE MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 S 4TH ST
MORTON MS
39117-3407
US

IV. Provider business mailing address

347 S 4TH ST
MORTON MS
39117-3407
US

V. Phone/Fax

Practice location:
  • Phone: 601-732-1524
  • Fax: 601-732-1572
Mailing address:
  • Phone: 601-732-1524
  • Fax: 601-732-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: 601-469-4861