1891735692 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 1891735692 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:
S. E. LACKEY MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1891735692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAGEE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39111-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-849-6440
Provider Business Mailing Address Fax Number:
601-849-7557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39074-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-469-4151
Provider Business Practice Location Address Fax Number:
601-469-3681
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCNULTY
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
601-849-4112

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  13-033 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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