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NPI Code Detail

MEDICARE: INDEPENDENT HEALTHCARE MANAGEMENT, INC

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
1207Q00000XFamily Medicine Physician
2261QR1300XRural Health Clinic/Center

General Provider Information

NPI Number : 1649761685
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDEPENDENT HEALTHCARE MANAGEMENT, INC
Provider Business Mailing Address
First Line : 100 PIONEER WAY
Second Line :
City : MAGEE
State : MS
Zip : 39111-5501
Country : US
Telephone Number : 601-849-6440
Fax Number : 600-849-1332
Provider Business Practice Location Address
First Line : 1 MEDICAL LN STE B
Second Line :
City : FOREST
State : MS
Zip : 39074-4039
Country : US
Telephone Number : 601-469-4861
Fax Number :
Authorized Official
Title or Position : COB
Name : JOHN P LEE
Credential : MD
Telephone Number : 601-469-4861
Provider Enumeration Date : 05/25/2018
Last Update Date : 05/26/2020

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Directions to “INDEPENDENT HEALTHCARE MANAGEMENT, INC ” Practice Location

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