Healthcare Provider Details

I. General information

NPI: 1275130601
Provider Name (Legal Business Name): INDEPENDENT HEALTHCARE MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9425 EASTSIDE DRIVE EXT STE B
NEWTON MS
39345-8069
US

IV. Provider business mailing address

100 PIONEER WAY
MAGEE MS
39111-5501
US

V. Phone/Fax

Practice location:
  • Phone: 601-683-0330
  • Fax: 601-635-3746
Mailing address:
  • Phone: 601-849-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN P LEE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 601-469-4861