NPIMap

Organization Active NPI

Clinics of the Southeast LLC

  • Rural Health Clinic/Center
  • Bogalusa, LA
National Provider Identifier
1053979815
Registry record updated Jun 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLINICS OF THE SOUTHEAST LLC
Practice address
405 Avenue F
Bogalusa, LA 70427-3633
Phone
(985) 732-1568
Fax
(985) 732-4458
NPI assigned
Jun 5, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2019

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

Authorized official

Name
Dr. Anthony Jude Palazzo, MDNPI 1063457554
Title
Ceo
Phone
(985) 732-1568

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

405 Avenue F
Bogalusa, LA 70427-3633

Mailing address

PO Box 370
Bogalusa, LA 70429-0370
Phone (985) 732-1568

Other names 1

  • Bogalusa Pediatric Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190926001826 LA Part A Provider - Rural Health Clinic 6709116239 Practice locations: Bogalusa, LA
O20210608001420 LA Part B Supplier - Clinic/Group Practice 6709116239 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
Practice locations: Bogalusa, LA

Rural health clinic certification: CCN 193953

Legal name
CLINICS OF THE SOUTHEAST LLC
Doing business as
BOGALUSA PEDIATRIC CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 13, 2020
Last certification
Feb 18, 2023
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Apr 23, 2019 in LA
Enrollment address
405 Avenue F
Bogalusa, LA 70427-3633

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Clinics of the Southeast LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Anthony J Palazzo Individual 5% Or Greater Direct Ownership InterestCeo Apr 23, 2019 95%
Corporate Officer Apr 23, 2019 95%
Operational/Managerial Control Apr 23, 2019 95%
Celia Palazzo Individual 5% Or Greater Direct Ownership InterestPresident Apr 23, 2019 5%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Anthony Jude Palazzo, M.D.
    • Pediatric Adolescent Medicine Physician
    • Bogalusa, LA
    • NPI 1063457554

    5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

    CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559692800000",
    "number": "1053979815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704290370",
            "telephone_number": "985-732-1568",
            "fax_number": "985-732-4458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 AVENUE F",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704273633",
            "telephone_number": "985-732-1568",
            "fax_number": "985-732-4458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICS OF THE SOUTHEAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-05",
        "last_updated": "2019-06-05",
        "status": "A",
        "authorized_official_last_name": "PALAZZO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "JUDE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "985-732-1568",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bogalusa Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bogalusa, LA

Sources for this page

Verify at the official NPI Registry.