MB Costello Enterprises LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

MB COSTELLO ENTERPRISES LLC

Doing business as

PCA Pain Care Center

Practice address

1501 Lakeland Dr Ste 251
Jackson, MS 39216-4848

Phone

(601) 321-8000

Fax

(601) 321-8001

NPI assigned

May 13, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bruce Costello, DC

Title

Franchisee

Phone

(404) 354-3111

Specialties & licenses 1

Addresses

Other names 1

• PCA Pain Care Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317254400000",
    "number": "1982996567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 LAKELAND DR",
            "address_2": "SUITE 251",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164834",
            "telephone_number": "601-320-8000",
            "fax_number": "601-320-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 LAKELAND DR STE 251",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164848",
            "telephone_number": "601-321-8000",
            "fax_number": "601-321-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MB COSTELLO ENTERPRISES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-13",
        "last_updated": "2011-09-29",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "FRANCHISEE",
        "authorized_official_telephone_number": "404-354-3111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PCA Pain Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Grayson Maynard, DO
• Grace Ann Mayne, WHNP
• Nina Nicole Mayo, NP
• Kevin Michael Mays, M.D.
• Kayla Mayze
• Linda Angela Mbah, MD
• Nicholas McAfee, PHD
• Mary Lee McAlexander, M.S.
• Angela McAllister
• Lindsay J McAlpin, PA

• Pain Medicine (Anesthesiology) Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Pain Medicine (Anesthesiology) Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.