NPIMap

Organization Active NPI

Independent Healthcare Management, Inc.

Doing business as S.E. Lackey Memorial Hospital

  • Critical Access Hospital
  • Forest, MS
National Provider Identifier
1285956334
Registry record updated May 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
13-033 Issued in MS
Legal business name
INDEPENDENT HEALTHCARE MANAGEMENT, INC.
Doing business as
S.E. Lackey Memorial Hospital
Practice address
330 N Broad St
Forest, MS 39074-3508
Phone
(601) 469-4151
Fax
(601) 469-3681
NPI assigned
Feb 17, 2010
Last updated
May 26, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2020

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

Authorized official

Name
John P Lee
Title
Chairman of the Board
Phone
(601) 849-6440

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 13-033 MS Primary
Certified Registered Nurse Anesthetist 367500000X 13-033 MS

Addresses

Primary practice location

330 N Broad St
Forest, MS 39074-3508

Mailing address

330 N Broad St
Forest, MS 39074-3508
Phone (601) 469-4151

Other identifiers 1

IdentifierTypeStateIssuer
09013844MedicaidMS

Other names 1

  • S.E. Lackey Memorial Hospital Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bruce Hospital ER15 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

NPI Registry JSON

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590451200000",
    "number": "1285956334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N BROAD ST",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390743508",
            "telephone_number": "601-469-4151",
            "fax_number": "601-469-3681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N BROAD ST",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390743508",
            "telephone_number": "601-469-4151",
            "fax_number": "601-469-3681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT HEALTHCARE MANAGEMENT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-17",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD",
        "authorized_official_telephone_number": "601-849-6440"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MS",
            "license": "13-033",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "13-033",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013844",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "S.E. Lackey Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "S.E. 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 May 26, 2020; 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.