NPIMap

Organization Active NPI

Mall Services, LLC

Doing business as Medical Mall Health Services at CMMC

  • Health Service Clinic/Center
  • Jackson, MS
National Provider Identifier
1548539117
Registry record updated Dec 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
10119 Issued in MS
Legal business name
MALL SERVICES, LLC
Doing business as
Medical Mall Health Services at CMMC
Practice address
1860 Chadwick Dr
Suite 305
Jackson, MS 39204-3463
Phone
(601) 503-4960
Fax
(601) 982-0459
NPI assigned
Dec 27, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2011

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

Authorized official

Name
Dr. Aaron Shirley, M.D.
Title
Project Director
Phone
(601) 982-0673

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 10119 MS Primary

Addresses

Primary practice location

1860 Chadwick Dr
Suite 305
Jackson, MS 39204-3463

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
08406271MedicaidMS

Other names 1

  • Medical Mall Health Services at CMMC Doing business as

National Provider Directory

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

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": "1324944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324944000000",
    "number": "1548539117",
    "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": "1860 CHADWICK DR",
            "address_2": "SUITE 305",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043463",
            "telephone_number": "601-503-4960",
            "fax_number": "601-982-0459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-27",
        "last_updated": "2011-12-27",
        "status": "A",
        "authorized_official_last_name": "SHIRLEY",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "PROJECT DIRECTOR",
        "authorized_official_telephone_number": "601-982-0673",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MS",
            "license": "10119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08406271",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Mall Health Services at CMMC",
            "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 Dec 27, 2011; 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.