MB COSTELLO ENTERPRISES LLC (NPI# 1982996567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982996567 |
| Entity Type | Organization |
| Organization Name | MB COSTELLO ENTERPRISES LLC |
| Other Organization Name | PCA PAIN CARE CENTER |
| Practice Address |
1501 Lakeland Dr Ste 251 Jackson MS 39216-4848 |
| Mailing Address |
1501 Lakeland Dr Suite 251 Jackson MS 39216-4834 |
| Practice Telephone | 6013218000 |
| Practice Fax Number | 6013218001 |
| Mailing Telephone | 6013208000 |
| Mailing Fax Number | 6013208001 |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2011-09-29 |
| Authorized Official Name | DR. BRUCE COSTELLO (FRANCHISEE) |
| Authorized Official Telephone | 4043543111 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PCA Pain Care Center | Doing Business As Name - Organization |
| Street Address |
1501 LAKELAND DR STE 251 |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4848 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 207LP2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pain Medicine |
| An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841286853 | Frank Edwin Jordan | Anesthesiology | 160c W University Pkwy, Jackson, TN 38305-1667 | 2005-09-26 |
| 1841774262 | Wa Foote Memorial Hospital Inc | Anesthesiology | 205 N East Ave, Jackson, MI 49201-1753 | 2018-09-21 |
| 1316331218 | Bhumika Sherdiwala | Anesthesiology | 817 Court St, Jackson, CA 95642-2156 | 2015-03-27 |
| 1962823344 | Jackson Pain Center Pa | Anesthesiology | 1151 N State St, Suite 311, Jackson, MS 39202-2407 | 2014-01-02 |
| 1265720791 | Joel Dale Nutt | Anesthesiology | 2500 N State St, Jackson, MS 39216-4500 | 2011-07-18 |
| 1114233228 | Jackson Interventional Pain Center LLC | Anesthesiology | 379 Hospital Blvd, Jackson, TN 38305-2177 | 2010-08-26 |
| 1447446570 | Pain Consultants of West Tennessee | Anesthesiology | 160 W University Pkwy Ste C, Jackson, TN 38305-1667 | 2007-09-21 |
| 1982811097 | Mississippi Pain Management | Anesthesiology | 1 Layfair Dr, Ste 400, Jackson, MS 39232-9717 | 2007-05-17 |
| 1528190196 | Ruben Fernandez Jr. | Anesthesiology | 810 W Forest Ave, Jackson, TN 38301-3942 | 2007-03-09 |
| 1043309271 | Cardiac Anesthesia Group | Anesthesiology | 810 W Forest Ave, Jackson, TN 38301-3942 | 2006-10-12 |
| 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.