Organization
COMPREHENSIVE PAIN CENTER FOR SURGERY
Active
Other names
Fountains Specialty Surgical Center
Organization subpart
No
Provider details
NPI number
Authorized official
LEONEL K VANCE M.D. (MEDICAL DIRECTOR)
(769) 300-0720
Entity
Organization
Contact information
Practice address
129 FOUNTAINS BLVD., MADISON, MS 39110
(769) 300-0720
(769) 300-0721
Mailing address
129 FOUNTAINS BLVD, MADISON, MS 39110
(769) 300-0720
(769) 300-0721
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1525725
—
MS
Enumeration date
06/27/2013
Last updated
03/05/2025
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