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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1225720345
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	:

Provider Business Practice Location Address
First Line	:	505 AIRPORT RD STE D
Second Line	:
City	:	FOREST
State	:	MS
Zip	:	39074-4033
Country	:	US
Telephone Number	:	601-333-0986
Fax Number	:	601-333-0987

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

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	06/06/2023

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