Organization
BROOKSVILLE MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERNEST ROY STUART JR. (PRESIDENT)
(662) 738-4424
Entity
Organization
Contact information
Practice address
139 N. OLIVER ST., BROOKSVILLE, MS 39739-0348
(662) 738-4424
(662) 738-4615
Mailing address
PO BOX 348, 139 N. OLIVER ST., BROOKSVILLE, MS 39739-0348
(662) 738-4424
(662) 738-4615
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
253912
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014825
—
MS
Enumeration date
11/16/2006
Last updated
08/22/2020
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