NPIMap

Organization Active NPI

Mall Services, LLC

  • Clinic/Center
  • Jackson, MS
National Provider Identifier
1881878577
Registry record updated Dec 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
R729183 Issued in MS
Legal business name
MALL SERVICES, LLC
Doing business as
Lanier Health Clinic
Practice address
833 Maple St
Jackson, MS 39203-3844
Phone
(601) 982-0673
NPI assigned
Dec 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2007

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

Authorized official

Name
Aaron Shirley, MD
Title
Director
Phone
(601) 982-0673

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X R729183 MS Primary

Addresses

Primary practice location

833 Maple St
Jackson, MS 39203-3844

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
08151531MedicaidMS

Other names 1

  • Lanier Health 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": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1881878577",
    "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": "833 MAPLE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392033844",
            "telephone_number": "601-982-0673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "SHIRLEY",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-982-0673",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": "R729183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08151531",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lanier Health 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 Dec 18, 2007; 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.