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CAH251300-12 INDEPENDENT HEALTHCARE MANAGMENT, INC. D/B/A SE LACKEY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
INDEPENDENT HEALTHCARE MANAGMENT, INC. D/B/A SE LACKEY MEMORIAL HOSPITAL
Subdivision Name
INDEPENDENT HEALTHCARE MANAGEMENT I - Forest Family Medical Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH251300-12
Medicare Provider Number
251300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/4/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/17/2019
Last Recertification Date
9/19/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Lackey Memorial Hospital
sydney sawyer, ceo
(601) 469-4151 Ext: 301
Primary Contact
Lackey Memorial Hospital - Magee, MS
Carol Denton, Integrity Officer/Privacy & Security
(601) 209-3483
Addresses
Street Address
1 MEDICAL LN STE B
FOREST FAMILY PRACTICE
FOREST, MS 39074-4039
Billing Address
Independent Healthcare Management, Inc.
P O Box 1460
Magee, MS 39111
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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