Organization
MALL SERVICES, LLC
Active
Parent organization
JACKSON MEDICAL MALL FOUNDATION
Other names
Westside Community Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
JACKSON MEDICAL MALL FOUNDATION
Authorized official
CHERYL R WALKER (CLINIC MANAGER)
(601) 982-0673
Entity
Organization
Contact information
Practice address
1066 WIGGINS ROAD, JACKSON, MS 39209
(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
261QC1500X
Community Health Clinic/Center
R656046
MS
261QC1500X
Community Health Clinic/Center
Primary
V-014
MS
Other
Enumeration date
08/04/2008
Last updated
08/04/2008
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