NPIMap

Organization Active NPI

Mall Services, LLC

  • Clinic/Center
  • Jackson, MS
National Provider Identifier
1245477165
Registry record updated Jan 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
R656046 Issued in MS
Legal business name
MALL SERVICES, LLC
Doing business as
Convenient Care Mobile Clinic
Practice address
350 W Woodrow Wilson Ave
Suite 615
Jackson, MS 39213-7681
Phone
(601) 982-0673
Fax
(601) 982-0459
NPI assigned
Jan 14, 2009
Organization subpart
Yes
Parent organization
CONVENIENT CARE CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2009

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

Authorized official

Name
Mrs. Christal Rogers, LPN
Title
Office Assistant
Phone
(601) 982-0673

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X R656046 MS Primary

Addresses

Primary practice location

350 W Woodrow Wilson Ave
Suite 615
Jackson, MS 39213-7681

Mailing address

350 W Woodrow Wilson Ave
Suite 615
Jackson, MS 39213-7681
Phone (601) 982-0673

Other identifiers 3

IdentifierTypeStateIssuer
08406271MedicaidMS
00115980MedicaidMS
1710084504OtherNPI

Other names 1

  • Convenient Care Mobile Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mall Services LLC8 organizations share this tax ID, including this one
Part of
Mall Services LLC

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231891200000",
    "number": "1245477165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 W WOODROW WILSON AVE",
            "address_2": "SUITE 615",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392137681",
            "telephone_number": "601-982-0673",
            "fax_number": "601-982-0459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W WOODROW WILSON AVE",
            "address_2": "SUITE 615",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392137681",
            "telephone_number": "601-982-0673",
            "fax_number": "601-982-0459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONVENIENT CARE CLINIC",
        "enumeration_date": "2009-01-14",
        "last_updated": "2009-01-14",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "CHRISTAL",
        "authorized_official_title_or_position": "OFFICE ASSISTANT",
        "authorized_official_telephone_number": "601-982-0673",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": "R656046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08406271",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00115980",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1710084504",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Convenient Care Mobile Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2009; 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.