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MALL SERVICES LLC NPI 1063659340


NPI Information

NPI: 1063659340
Provider Name: MALL SERVICES, LLC

Doing Business As: 809 CONVENIENT CARE CLINIC

Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
809 N STATE ST
JACKSON, MS
ZIP 39202
Phone: (601) 982-0673
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MALL SERVICES, LLC is a family nurse practitioner in Jackson, MS. MALL SERVICES, LLC NPI is 1063659340. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As 809 Convenient Care Clinic.

The provider's business location address is:

809 N STATE ST
JACKSON, MS
ZIP 39202-604
Phone: (601) 982-0673
Fax: (601) 982-0459

The provider's authorized official is Christal Rogers .
The authorized official title is Office Assistant and has the following contact phone number (601) 982-0673.

The enumeration date for this NPI number is 1/8/2009 and was last updated on 1/8/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1172V00000XCommunity Health WorkerP320574MISSISSIPPINo
2363LF0000XNurse PractitionerFamilyR656046MISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100115980MEDICAIDMISSISSIPPI
208406271MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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