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Organization
MB COSTELLO ENTERPRISES LLC
Active
Organization
MB COSTELLO ENTERPRISES LLC
Active
Other names
PCA Pain Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE COSTELLO DC (FRANCHISEE)
(404) 354-3111
Entity
Organization
Contact information
Practice address
1501 LAKELAND DR STE 251, JACKSON, MS 39216-4848
(601) 321-8000
(601) 321-8001
Mailing address
1501 LAKELAND DR, SUITE 251, JACKSON, MS 39216-4834
(601) 320-8000
(601) 320-8001
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Enumeration date
05/13/2011
Last updated
09/29/2011
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