Healthcare Provider Details

I. General information

NPI: 1356848014
Provider Name (Legal Business Name): FLOWOOD PAIN CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STONE CREEK BLVD STE 500
FLOWOOD MS
39232-8210
US

IV. Provider business mailing address

PO BOX 649113
DALLAS TX
75264-9113
US

V. Phone/Fax

Practice location:
  • Phone: 601-420-2040
  • Fax: 601-420-2356
Mailing address:
  • Phone: 601-339-2065
  • Fax: 855-343-5763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateMS

VIII. Authorized Official

Name: TERESA GREEN
Title or Position: REVENUE MANAGER
Credential: CPC
Phone: 855-343-5763