Organization
MALL SERVICES, LLC
Active
Other names
Convenient Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL R WALKER (ADMINSTRATIVE ASSOCIATE)
(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
261QP2300X
Primary Care Clinic/Center
R729183
MS
261QP2300X
Primary Care Clinic/Center
Primary
V-014
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07606048
—
MS
05
—
08406271
—
MS
Enumeration date
11/28/2006
Last updated
08/22/2020
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