NPIMap

Organization Active NPI

Medical Mall Services of Mississippi, LLC

  • Health Service Clinic/Center
  • Jackson, MS
National Provider Identifier
1679843452
Registry record updated Jan 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
MEDICAL MALL SERVICES OF MISSISSIPPI, LLC
Doing business as
Medical Mall Health Services
Practice address
350 W Woodrow Wilson Ave
Jackson, MS 39213-7681
Phone
(610) 672-2733
NPI assigned
Jan 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2012

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

Authorized official

Name
Mr. James Clayton Bardwell
Title
Chief Financial Officer
Phone
(202) 459-4766

Specialties & licenses 1

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

Addresses

Primary practice location

350 W Woodrow Wilson Ave
Jackson, MS 39213-7681

Mailing address

2820 Bladensburg Rd NE
2ND Floor
Washington, DC 20018-4106
Phone (202) 459-4766

Other names 1

  • Medical Mall Health Services Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326153600000",
    "number": "1679843452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 BLADENSBURG RD NE",
            "address_2": "2ND FLOOR",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200184106",
            "telephone_number": "202-459-4766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392137681",
            "telephone_number": "610-672-2733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL MALL SERVICES OF MISSISSIPPI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-10",
        "last_updated": "2012-01-10",
        "status": "A",
        "authorized_official_last_name": "BARDWELL",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "CLAYTON",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "202-459-4766",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Mall Health Services",
            "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 10, 2012; 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.