# INDEPENDENT HEALTHCARE MANAGEMENT, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SE Lackey Memorial Hospital
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245905405
- **Authorized official:** JOHN LEE MD (CHAIRMAN OF BOARD)
- **Authorized official phone:** (601) 469-4861

## Contact information

- **Practice address:** 516 AIRPORT RD, FOREST, MS 39074-4032
- **Practice address phone:** (601) 469-4151
- **Practice address fax:** (601) 469-3681
- **Mailing address:** PO BOX 1460, MAGEE, MS 39111-1460
- **Mailing address phone:** (601) 849-6440
- **Mailing address fax:** (601) 849-1332

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/10/2021
- **Last updated:** 08/10/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 13-033 | HOSPITAL LICENSE | MS |