Organization
INDEPENDENT HEALTHCARE MANAGEMENT, INC
Active
Other names
Lackey Pain Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P LEE MD (MEDICAL DIRECTOR)
(601) 469-4861
Entity
Organization
Contact information
Practice address
9425 EASTSIDE DRIVE EXT STE B, NEWTON, MS 39345-8069
(601) 683-0330
(601) 635-3746
Mailing address
100 PIONEER WAY, MAGEE, MS 39111-5501
(601) 849-6440
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13033
LICENSE
MS
Enumeration date
10/08/2020
Last updated
10/08/2020
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