Provider Demographics
NPI:1053082743
Name:CLINICS OF THE SOUTHEAST LLC
Entity Type:Organization
Organization Name:CLINICS OF THE SOUTHEAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:PALAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-735-7707
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70429-0370
Mailing Address - Country:US
Mailing Address - Phone:985-732-1568
Mailing Address - Fax:
Practice Address - Street 1:219 S BORDER DR
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3671
Practice Address - Country:US
Practice Address - Phone:985-732-1568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINIC OF THE SOUTHEAST LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center