Provider Demographics
NPI:1053979815
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:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:PALAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-732-1568
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:985-732-4458
Practice Address - Street 1:405 AVENUE F
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3633
Practice Address - Country:US
Practice Address - Phone:985-732-1568
Practice Address - Fax:985-732-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty