# INDEPENDENT HEALTHCARE MANAGEMENT, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lackey Pain Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275130601
- **Authorized official:** JOHN P LEE MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (601) 469-4861

## Contact information

- **Practice address:** 9425 EASTSIDE DRIVE EXT STE B, NEWTON, MS 39345-8069
- **Practice address phone:** (601) 683-0330
- **Practice address fax:** (601) 635-3746
- **Mailing address:** 100 PIONEER WAY, MAGEE, MS 39111-5501
- **Mailing address phone:** (601) 849-6440

## Taxonomy

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

## Other

- **Enumeration date:** 10/08/2020
- **Last updated:** 10/08/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 13033 | LICENSE | MS |