Healthcare Provider Details

I. General information

NPI: 1528109972
Provider Name (Legal Business Name): FLOWOOD VASCULAR ACCESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAKELAND SQUARE EXT STE B
FLOWOOD MS
39232-7607
US

IV. Provider business mailing address

PO BOX 416471
BOSTON MA
02241-6471
US

V. Phone/Fax

Practice location:
  • Phone: 601-936-0890
  • Fax: 601-936-0891
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK KLEIN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 601-981-1610