Organization
MALL SERVICES, LLC
Active
Parent organization
CONVENIENT CARE CLINIC
Other names
Convenient Care Mobile Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
CONVENIENT CARE CLINIC
Authorized official
MRS. CHRISTAL ROGERS LPN (OFFICE ASSISTANT)
(601) 982-0673
Entity
Organization
Contact information
Practice address
350 W WOODROW WILSON AVE, SUITE 615, JACKSON, MS 39213-7681
(601) 982-0673
(601) 982-0459
Mailing address
350 W WOODROW WILSON AVE, SUITE 615, JACKSON, MS 39213-7681
(601) 982-0673
(601) 982-0459
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
R656046
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115980
—
MS
05
—
08406271
—
MS
01
—
1710084504
NPI
—
Enumeration date
01/14/2009
Last updated
01/14/2009
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