NPIMap

Organization Active NPI

Mall Services, LLC

  • Family Medicine Physician
  • Jackson, MS
National Provider Identifier
1699005983
Registry record updated Jan 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MALL SERVICES, LLC
Doing business as
THE VILLAGE CLINIC
Practice address
386 Raymond Rd
Building 30
Jackson, MS 39204-3700
Phone
(601) 982-0673
Fax
(601) 982-0459
NPI assigned
Jan 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2010

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

Authorized official

Name
Mrs. Christal Rogers, LPN
Title
Clinic Manager
Phone
(601) 952-0673

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

386 Raymond Rd
Building 30
Jackson, MS 39204-3700

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
00122194MedicaidMS
00122254MedicaidMS
04135059MedicaidMS

Other names 1

  • THE VILLAGE CLINIC 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": "1262908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262908800000",
    "number": "1699005983",
    "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": "386 RAYMOND RD",
            "address_2": "BUILDING 30",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043700",
            "telephone_number": "601-982-0673",
            "fax_number": "601-982-0459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-08",
        "last_updated": "2010-01-08",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "CHRISTAL",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "601-952-0673",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00122194",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00122254",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04135059",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE VILLAGE 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 8, 2010; 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.