Medical Mall Health Services of Mississippi, LLC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

MEDICAL MALL HEALTH SERVICES OF MISSISSIPPI, LLC

Practice address

350 W Woodrow Wilson Ave
Suite 499a
Jackson, MS 39213-7681

Phone

(601) 700-7709

Fax

(877) 852-6352

NPI assigned

Apr 27, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Timothy P McNeil, RN

Title

Coo

Phone

(202) 344-5465

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Timothy Paul McNeill, RN

  • Registered Nurse
  • Jackson, MS
  • NPI 1093095812
  NPD

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426118400000",
    "number": "1194083139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 W WOODROW WILSON AVE.",
            "address_2": "SUITE 499A",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392137681",
            "telephone_number": "601-700-7709",
            "fax_number": "877-852-6352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W WOODROW WILSON AVE",
            "address_2": "SUITE 499A",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392137681",
            "telephone_number": "601-700-7709",
            "fax_number": "877-852-6352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL MALL HEALTH SERVICES OF MISSISSIPPI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-27",
        "last_updated": "2015-03-12",
        "status": "A",
        "authorized_official_last_name": "MCNEIL",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "202-344-5465",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Foundation of Central Ms Inc. (Baptist Premier)
• Medical Foundation of Central Ms, Inc
• Medical Foundation of Central Ms, Inc (MBMC Psychiatrists)
• Medical Genetics Lab
• Medical Mall Health Services, LLC (Medical Mall Health Services of Jackson)
• Medical Mall Services of Mississippi, LLC (Medical Mall Health Services)
• Medical Mall Vision Clinic
• Medicomp, Inc (Medicomp Physical Therapy Jackson)
• Medigo LLC

• Primary Care Nurse Practitioner in Jackson, MS
• Providers in Jackson, MS by specialty
• Primary Care Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2015; 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.