Brooksville Clinical Laboratory, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

BROOKSVILLE CLINICAL LABORATORY, INC.

Practice address

139 N Oliver Street
Brooksville, MS 39739

Phone

(662) 738-4424

Fax

(662) 738-4615

NPI assigned

Feb 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ernest R Stuart

Title

Administrator

Phone

(662) 738-4424

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023150786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 348",
            "city": "BROOKSVILLE",
            "state": "MS",
            "postal_code": "397390348",
            "telephone_number": "662-738-4424",
            "fax_number": "662-738-4615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 N OLIVER STREET",
            "city": "BROOKSVILLE",
            "state": "MS",
            "postal_code": "39739",
            "telephone_number": "662-738-4424",
            "fax_number": "662-738-4615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSVILLE CLINICAL LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STUART",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "662-738-4424"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120679",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald James Anthony Jr.
• Brooksville Assisted Living Home Inc.
• Brooksville Medical Clinic Inc
• Drayer Physical Therapy Institute LLC
• Drayer Physical Therapy Mississippi LLC
• First Choice Family Medical Clinic, LLC
• First Choice Pharmacy, LLC

• All providers in Brooksville, MS
• Clinical Medical Laboratory in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.