Organization
INDEPENDENT HEALTHCARE MANAGEMENT, INC.
Active
Other names
Lackey Pediatric Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P LEE (CHAIRMAN OF THE BOARD)
(601) 849-6440
Entity
Organization
Contact information
Practice address
1129 HIGHWAY 35 S, SUITE 1, FOREST, MS 39074-8829
(601) 849-6440
(601) 849-1318
Mailing address
1129 HIGHWAY 35 S, SUITE 1, FOREST, MS 39074-8829
(601) 849-6440
(601) 849-1318
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
13-033
MS
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13033
LICENSE
MS
Enumeration date
08/29/2012
Last updated
05/26/2020
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