NPIMap

Organization Active NPI

Dr. K'S Family Medicine

  • Rural Health Clinic/Center
  • Bogalusa, LA
National Provider Identifier
1265971147
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DR. K'S FAMILY MEDICINE
Practice address
2781 S Columbia St
Suite a
Bogalusa, LA 70427-7962
Phone
(229) 869-0294
NPI assigned
Feb 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Keisha Harvey, M.D.NPI 1821355637
Title
President
Phone
(229) 829-0294

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
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2781 S Columbia St
Suite a
Bogalusa, LA 70427-7962

Mailing address

2871 S. Columbia St
Ste a
Bogalusa, LA 70427

Other identifiers 1

IdentifierTypeStateIssuer
MD206754OtherLSBME

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170504000198 LA Part B Supplier - Clinic/Group Practice 9335426121 Receives reassigned benefits from 5 practitioners
Practice locations: Bogalusa, LA
O20220517000507 LA Part A Provider - Rural Health Clinic 9335426121 Practice locations: Bogalusa, LA

Rural health clinic certification: CCN 198920

Legal name
DR KS FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 4, 2024
Last certification
Jan 4, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2015 in LA
Enrollment address
400 Louisiana Ave
Bogalusa, LA 70427-3323

National Provider Directory

National Provider Directory

Locations

400 Louisiana Ave
Bogalusa, LA 70427
Phone (985) 735-7372

2781 S Columbia St
Ste A
Bogalusa, LA 70427
Phone (229) 869-0294

2871 S Columbia St
Ste A
Bogalusa, LA 70427

2781 S Columbia St
Bogalusa, LA 70427
Phone (985) 241-5525

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Keisha D Harvey Individual W-2 Managing EmployeeMD; Apr 15, 2017

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1486944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1265971147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2871 S. COLUMBIA ST",
            "address_2": "STE A",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "70427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2781 S COLUMBIA ST",
            "address_2": "SUITE A",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704277962",
            "telephone_number": "229-869-0294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. K'S FAMILY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-13",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "HARVEY",
        "authorized_official_first_name": "KEISHA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "229-829-0294",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LSBME",
            "identifier": "MD206754",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bogalusa, LA

Sources for this page

Verify at the official NPI Registry.