1760778609 NPI number — INDEPENDENT HEALTHCARE MANAGEMENT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760778609 NPI number — INDEPENDENT HEALTHCARE MANAGEMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENT HEALTHCARE MANAGEMENT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760778609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17509 HWY 21
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEBASTOPOL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39359-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-625-9818
Provider Business Mailing Address Fax Number:
601-625-9904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17509 HWY 21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEBASTOPOL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39359-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-625-9818
Provider Business Practice Location Address Fax Number:
601-625-9904
Provider Enumeration Date:
06/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MCNULTY
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-849-6440

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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