# MB COSTELLO ENTERPRISES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PCA Pain Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982996567
- **Authorized official:** DR. BRUCE COSTELLO DC (FRANCHISEE)
- **Authorized official phone:** (404) 354-3111

## Contact information

- **Practice address:** 1501 LAKELAND DR STE 251, JACKSON, MS 39216-4848
- **Practice address phone:** (601) 321-8000
- **Practice address fax:** (601) 321-8001
- **Mailing address:** 1501 LAKELAND DR, SUITE 251, JACKSON, MS 39216-4834
- **Mailing address phone:** (601) 320-8000
- **Mailing address fax:** (601) 320-8001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/13/2011
- **Last updated:** 09/29/2011