809 Convenient Care Clinic

LBN: Mall Services, Llc
809 Convenient Care Clinic is an health care organization with primary practice located at 809 N State St , Jackson MS 39202-2604. The organization recently has 2 registered licenses in different health care specialties including Other Service Providers / Community Health Worker, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is the primary health care specialty. Mall Services, Llc can be contacted via phone (601) 982-0673, or through Rogers, Christal via phone (601) 982-0673.

Contact Information

Primary practice address
809 N State St Jackson MS 39202-2604
Phone: (601) 982-0673
Fax: (601) 982-0459
Website:
Map and Directions
Authorized official contact:
Name: Rogers, Christal Licensed Practical Nurse (LPN)
Phone: (601) 982-0673

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Community Health Worker 172V00000X P320574 Mississippi
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X R656046 Mississippi

Profile Details

NPI number 1063659340
LBN Legal business name Mall Services, Llc
DBA Doing business as 809 Convenient Care Clinic
Authorized official Rogers, Christal Licensed Practical Nurse (LPN)
Entity Organization
Organization subpart 1 No
Enumeration date Jan 8th, 2009
Last updated Jan 8th, 2009 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063659340 NPPES
Mississippi MEDICAID 00115980
Mississippi MEDICAID 08406271

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