NPIMap

Organization Active NPI

Independent Healthcare Management, Inc.

Doing business as SE Lackey Memorial Hospital

  • Clinic/Center
  • Forest, MS
National Provider Identifier
1245905405
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
INDEPENDENT HEALTHCARE MANAGEMENT, INC.
Doing business as
SE Lackey Memorial Hospital
Practice address
516 Airport Rd
Forest, MS 39074-4032
Phone
(601) 469-4151
Fax
(601) 469-3681
NPI assigned
Aug 10, 2021
Last updated
Aug 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Lee, MDNPI 1992806699
Title
Chairman of Board
Phone
(601) 469-4861

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

516 Airport Rd
Forest, MS 39074-4032

Mailing address

PO Box 1460
Magee, MS 39111-1460
Phone (601) 849-6440

Other identifiers 1

IdentifierTypeStateIssuer
13-033OtherMSHOSPITAL LICENSE

Other names 1

  • SE Lackey Memorial Hospital Doing business as

National Provider Directory

National Provider Directory
Tax ID family
SE Lackey Memorial Hosp15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

516 Airport Rd
Forest, MS 39074
Phone (601) 469-2020

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1245905405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1460",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391111460",
            "telephone_number": "601-849-6440",
            "fax_number": "601-849-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 AIRPORT RD",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390744032",
            "telephone_number": "601-469-4151",
            "fax_number": "601-469-3681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT HEALTHCARE MANAGEMENT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-08-10",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHAIRMAN OF BOARD",
        "authorized_official_telephone_number": "601-469-4861",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPITAL LICENSE",
            "identifier": "13-033",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SE Lackey Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.