Healthcare Provider Details

I. General information

NPI: 1023147113
Provider Name (Legal Business Name): SOUTHEAST COMMUNITY HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 SITMAN STREET
GREENSBURG LA
70441
US

IV. Provider business mailing address

POST OFFICE BOX 770
ZACHARY LA
70791
US

V. Phone/Fax

Practice location:
  • Phone: 225-222-6059
  • Fax: 225-222-6543
Mailing address:
  • Phone: 225-222-6059
  • Fax: 888-334-9386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. ALECIA CYPRIAN
Title or Position: CEO
Credential:
Phone: 225-306-2010