Provider Demographics
NPI:1194215681
Name:BROOKS MEDICAL CLINIC
Entity type:Organization
Organization Name:BROOKS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:SCHERUN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:662-331-1497
Mailing Address - Street 1:2113 SOUTH TATE STREET
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834
Mailing Address - Country:US
Mailing Address - Phone:662-331-1497
Mailing Address - Fax:662-331-1495
Practice Address - Street 1:2113 SOUTH TATE STREET
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834
Practice Address - Country:US
Practice Address - Phone:662-331-1497
Practice Address - Fax:662-331-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care