MALL SERVICES LLC NPI 1285700617

NPI Information

NPI: 1285700617
Provider Name: MALL SERVICES, LLC
Classification: Clinic/Center - 261QP2300X
Specialization: Primary Care
Entity Type: Organization
Doing Business As: CONVENIENT CARE CLINIC
Address: 350 W WOODROW WILSON AVE
SUITE 615
JACKSON, MS
ZIP 39213
Phone: (601) 982-0673

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NPI Details

MALL SERVICES, LLC is a primary care clinic center in Jackson, MS. MALL SERVICES, LLC NPI is 1285700617. The provider is registered as an organization entity type.
The provider Is Doing Business As Convenient Care Clinic.

The provider's business location address is:

350 W WOODROW WILSON AVE
SUITE 615
JACKSON, MS
ZIP 39213-681
Phone: (601) 982-0673
Fax: (601) 982-0459

The provider's authorized official is Cheryl R Walker .
The authorized official title is Adminstrative Associate and has the following contact phone number (601) 982-0673.

The enumeration date for this NPI number is 11/28/2006 and was last updated on 8/22/2020.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	R729183	MISSISSIPPI	No
2	261QP2300X	Clinic/Center	Primary Care	V-014	MISSISSIPPI	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	07606048	MEDICAID	MISSISSIPPI
2	08406271	MEDICAID	MISSISSIPPI

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: 11/21/2025

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