Healthcare Provider Details

I. General information

NPI: 1487800520
Provider Name (Legal Business Name): MISSISSIPPI VEIN INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 FOUNTAINS BLVD
MADISON MS
39110-6344
US

IV. Provider business mailing address

111 FOUNTAINS BLVD
MADISON MS
39110-6344
US

V. Phone/Fax

Practice location:
  • Phone: 601-707-7026
  • Fax: 601-707-7054
Mailing address:
  • Phone: 601-707-7026
  • Fax: 601-707-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN MICHAEL MANNING
Title or Position: PRESIDENT
Credential: M.D.
Phone: 601-927-8176