25D0878508 CLIA NUMBER - BROOKHAVEN INTERNAL MEDICINE PA

Laboratory Demographics

  • CLIA Code: 25D0878508
  • Facility Name: BROOKHAVEN INTERNAL MEDICINE PA
  • Facility Address: 527 SILVER CROSS DRIVE
    BROOKHAVEN, MS
    ZIP 39601
  • Facility Phone: 601 835-0507
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRYAN S. CALCOTE
  • NPI Number: 1699884528
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D0878508
LAB Type Physician Office
Facility Name BROOKHAVEN INTERNAL MEDICINE PA
Street 527 SILVER CROSS DRIVE
City BROOKHAVEN
State MS
ZIP 39601
Phone 601 835-0507
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/18/2024
Certificate Expiration Date 5/17/2026
Facility Type Physician Office
Lab Director BRYAN S. CALCOTE

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This page was last updated on: 9/29/2025