# MALL SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CONVENIENT CARE CLINIC
- **Other names:** Convenient Care Mobile Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1245477165
- **Legal business name:** CONVENIENT CARE CLINIC
- **Authorized official:** MRS. CHRISTAL ROGERS LPN (OFFICE ASSISTANT)
- **Authorized official phone:** (601) 982-0673

## Contact information

- **Practice address:** 350 W WOODROW WILSON AVE, SUITE 615, JACKSON, MS 39213-7681
- **Practice address phone:** (601) 982-0673
- **Practice address fax:** (601) 982-0459
- **Mailing address:** 350 W WOODROW WILSON AVE, SUITE 615, JACKSON, MS 39213-7681
- **Mailing address phone:** (601) 982-0673
- **Mailing address fax:** (601) 982-0459

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | R656046 | MS | Yes |

## Other

- **Enumeration date:** 01/14/2009
- **Last updated:** 01/14/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00115980 | — | MS |
| 05 | — | 08406271 | — | MS |
| 01 | — | 1710084504 | NPI | — |