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General NPI Number Information
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NPI Number | 1124275565
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PAIN CENTER OF MISSISSIPPI
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 129 FOUNTAINS BLVD
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City | MADISON
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State | MS
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Zip | 39110
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Country | US
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Telephone | 769-300-0730
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Fax | 601-949-2782
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Provider Business Mailing Address
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Address Line | 129 FOUNTAINS BLVD
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City | MADISON
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State | MS
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Zip | 39110
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Country | US
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Telephone | 601-949-9994
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEONEL KEVIN VANCE
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Credential | M.D.
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Telephone | 769-300-0730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 16855
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License Number State | MS
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