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Brookhaven Medical Center, PLLC

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Company Details

Name: Brookhaven Medical Center, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Dissolved
Effective Date: 25 Mar 2005 (20 years ago)
Business ID: 869936
State of Incorporation: MISSISSIPPI

Agent

Name Role Address
Dr. Deborah Brooks Agent 785 Ohio, Suite 2 D, Clarksdale, MS 38614

Member

Name Role Address
Ross, Tom T. Jr. Member 123 Court StreetP.O. Box 1196, Clarksdale, MS 38614

National Provider Identifier

NPI Number:
1972639060

Authorized Person:

Name:
MRS. DEBORAH BROOKS
Role:
PHYSICIAN
Phone:

Taxonomy:

Selected Taxonomy:
261QC1500X - Community Health Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
6626249971

Filings

Type Status Filed Date Description
Failure to File AR Filed 2011-12-05 Failure to File AR
Formation Form Filed 2005-03-25 Formation

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Date of last update: 01 Jul 2025

Sources: Company Profile on Mississippi Secretary of State Website