Provider Demographics
NPI:1316557986
Name:INDEPENDENT HEALTHCARE MANAGEMENT INC
Entity Type:Organization
Organization Name:INDEPENDENT HEALTHCARE MANAGEMENT INC
Other - Org Name:149 PEDIATRIC AND FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-469-4151
Mailing Address - Street 1:PO BOX D
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-0558
Mailing Address - Country:US
Mailing Address - Phone:601-469-4151
Mailing Address - Fax:601-469-9927
Practice Address - Street 1:376 SIMPSON HIGHWAY 149 STE 300
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3569
Practice Address - Country:US
Practice Address - Phone:601-849-6440
Practice Address - Fax:601-849-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty