1154670719 NPI number — INDEPENDENT HEALTHCARE MANAGEMENT, INC.

Table of content: (NPI 1154670719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154670719 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:
1154670719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1129 HIGHWAY 35 S
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
FOREST
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39074-8829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-849-6440
Provider Business Mailing Address Fax Number:
601-849-1318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1129 HIGHWAY 35 S
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FOREST
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39074-8829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-849-6440
Provider Business Practice Location Address Fax Number:
601-849-1318
Provider Enumeration Date:
08/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CHAIRMAN OF THE BOARD
Authorized Official Telephone Number:
601-849-6440

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  13-033 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13033 . This is a "LICENSE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com