LSP Southeast, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LSP SOUTHEAST, LLC

Practice address

290 Hancock Square Dr
Bay St Louis, MS 39520-1634

Phone

(480) 297-2184

NPI assigned

May 17, 2023

Organization subpart

No

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

Authorized official

Name

Alyssa Zelkovich

Title

Managing Partner

Phone

(480) 297-2184

Specialties & licenses 1

Addresses

Other names 1

• Laboratory Service Partners LLC Other name

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1684281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1104517424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 HANCOCK SQUARE DR",
            "city": "BAY ST LOUIS",
            "state": "MS",
            "postal_code": "395201634",
            "telephone_number": "480-297-2184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 HANCOCK SQUARE DR",
            "city": "BAY ST LOUIS",
            "state": "MS",
            "postal_code": "395201634",
            "telephone_number": "480-297-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LSP SOUTHEAST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-17",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "ZELKOVICH",
        "authorized_official_first_name": "ALYSSA",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "480-297-2184"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laboratory Service Partners LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Laboratory Service Partners LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Amy Larue, N.D.
• LBS Unlimited
• Joseph Rillens Lee, M.D.
• Jasmine Tiya Lewis
• Elizabeth Leyva, CMHT
• M Powell LLC
• M. Bert Keel Jr DMD PA
• Magnolia Weight Loss LLC
• Maryellen Mann, PCMHT
• Mary Dianne Martin, CRNA

• Clinical Medical Laboratory in Bay St Louis, MS
• Providers in Bay St Louis, MS by specialty
• Clinical Medical Laboratory in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.