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MALL SERVICES LLC NPI 1699005983


NPI Information

NPI: 1699005983
Provider Name: MALL SERVICES, LLC

Doing Business As: THE VILLAGE CLINIC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
386 RAYMOND RD
BUILDING 30
JACKSON, MS
ZIP 39204
Phone: (601) 982-0673
Get Directions

MALL SERVICES, LLC is a family medicine in Jackson, MS. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. MALL SERVICES, LLC NPI is 1699005983. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As The Village Clinic.

The provider's business location address is:

386 RAYMOND RD
BUILDING 30
JACKSON, MS
ZIP 39204-700
Phone: (601) 982-0673
Fax: (601) 982-0459

The provider's authorized official is Christal Rogers .
The authorized official title is Clinic Manager and has the following contact phone number (601) 952-0673.

The enumeration date for this NPI number is 1/8/2010 and was last updated on 1/8/2010.


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
1207Q00000XFamily MedicineYes

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
1512I080303MEDICARE PINMISSISSIPPI
2251964MEDICARE OSCAR/CERTIFICATIONMISSISSIPPI
300122194MEDICAIDMISSISSIPPI
404135059MEDICAIDMISSISSIPPI
5C02181MEDICARE PINMISSISSIPPI
6C03785MEDICARE UPINMISSISSIPPI
7H12744MEDICARE UPINMISSISSIPPI
800122254MEDICAIDMISSISSIPPI
91457562175MEDICARE PINMISSISSIPPI

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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