MEDICAL MALL SERVICES OF MISSISSIPPI, LLC (NPI# 1679843452) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679843452 |
| Entity Type | Organization |
| Organization Name | MEDICAL MALL SERVICES OF MISSISSIPPI, LLC |
| Other Organization Name | MEDICAL MALL HEALTH SERVICES |
| Practice Address |
350 W Woodrow Wilson Ave Jackson MS 39213-7681 |
| Mailing Address |
2820 Bladensburg Rd Ne 2nd Floor Washington DC 20018-4106 |
| Practice Telephone | 6106722733 |
| Mailing Telephone | 2024594766 |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2012-01-10 |
| Authorized Official Name | MR. JAMES CLAYTON BARDWELL (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 2024594766 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Medical Mall Health Services | Doing Business As Name - Organization |
| Street Address |
350 W WOODROW WILSON AVE |
| City | JACKSON |
| State | MS |
| Zip Code | 39213-7681 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184607210 | Srinivasan Vijayakumar | Radiology | 350 W Woodrow Wilson Ave, Suite 16, Jackson, MS 39213-7681 | 2005-11-22 |
| 1487285268 | Andreina Guedez Mijares | Dietitian, Registered | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2020-01-30 |
| 1114492725 | Kandis Vechelle Backus | Pharmacist | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2018-10-10 |
| 1780104646 | Jamie Simonson Dean | Nurse Practitioner | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2017-06-22 |
| 1730610775 | Take Care Pharmacy | Pharmacy | 350 W Woodrow Wilson Ave, Suite 311, Jackson, MS 39213-7681 | 2017-03-22 |
| 1891236725 | Christina Purviance | Nurse Practitioner | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2017-03-11 |
| 1265983316 | Molly Sullivan | Nurse Practitioner | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2016-10-24 |
| 1982057345 | Flora K. Green | Nurse Practitioner | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2016-07-20 |
| 1619346822 | Shundra Wilson | Nurse Practitioner | 350 W Woodrow Wilson Ave, Jackson, MS 39213-7681 | 2015-09-17 |
| 1336521343 | Karen Cathey | Counselor | 350 W Woodrow Wilson Ave, Suite 3572, Jackson, MS 39213-7681 | 2015-06-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679117980 | Cynthia Bailey | Technician | 916 Carnation Street, Jackson, MS 39213 | 2019-10-30 |
| 1871136374 | Shirley Collins Williams | Technician | 3132 Sage St, Jackson, MS 39213 | 2019-10-28 |
| 1275057069 | Nikita Patel | Pharmacist | 830 West Woodrow Wilson Avenue, Jackson, MS 39213 | 2017-08-02 |
| 1346782893 | Mississippi Smiles Dentistry LLC | Dentist | 310 W Woodrow Wilson Ave, 400, Jackson, MS 39213 | 2016-11-15 |
| 1730637521 | Ms Eyecare Associates of Jackson, Pllc. | Optometrist | 310 West Woodrow Wilson Avenue Suite 300, Jackson, MS 39213 | 2016-09-21 |
| 1518410778 | Assurance Home Health Services, LLC | Health Maintenance Organization | 1771 Hamilton Blvd., Jackson, MS 39213 | 2016-07-25 |
| 1831576180 | Dorothy Jeffries Anderson | Counselor | 350 Woodrow Wilson Ave, Jackson, MS 39213 | 2015-05-06 |
| 1740697275 | Sincere Home Care LLC. | Chore Provider | 5911 Holmes Ct, Jackson, MS 39213 | 2014-07-16 |
| 1629401088 | Deborah Diane Wright | Assisted Living Facility | 5911 Holmes Court, Jackson, MS 39213 | 2013-08-20 |
| 1245663251 | Methodist Home Road Living Center | Licensed Practical Nurse | 4560 Methodist Home Road, Jackson, MS 39213 | 2013-08-13 |
| Find all providers in zip 39213 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114471570 | Telemedicine Services of Mississippi | Clinic/Center | 2355b River Oaks Blvd, Jackson, MS 39211-3015 | 2016-08-15 |
| 1851706188 | Mediscan, LLC | Clinic/Center | 111 N Missouri St, Jackson, MO 63755-1831 | 2014-06-25 |
| 1245643204 | Meredith Figueroa | Clinic/Center | 20 Copper Ridge Cv, Jackson, TN 38305-5725 | 2014-06-07 |
| 1710260310 | Envision Eye Care, Inc | Clinic/Center | 1100 Jr Lynch St, Suite 5, Jackson, MS 39203-3311 | 2011-09-21 |
| 1962638791 | Choices for Children and Family - Forest Hill | Clinic/Center | 2607 Raymond Rd, Jackson, MS 39212-2252 | 2009-06-08 |
| 1083778617 | Choices for Children LLC | Clinic/Center | 2941 Terry Rd Ste 22, Jackson, MS 39212-3072 | 2006-12-20 |
| 1255719068 | Medical Care Alliance LLC | Clinic/Center | 5903 Ridgewood Rd, Suite 310, Jackson, MS 39211-3700 | 2015-05-13 |
| 1528470630 | Rebecca A. Griggs | Clinic/Center | 21 Security Dr, Jackson, TN 38305-3626 | 2014-05-22 |
| 1548539117 | Mall Services, LLC | Clinic/Center | 1860 Chadwick Dr, Suite 305, Jackson, MS 39204-3463 | 2011-12-27 |
| 1588964811 | Good Samaritan Family Walk-in Clinic, LLC | Clinic/Center | 1869 Highway 45 Byp, Suite 4, Jackson, TN 38305-2464 | 2010-11-03 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.