Healthcare Provider Details

I. General information

NPI: 1366617367
Provider Name (Legal Business Name): SOUTHEAST COMMUNITY HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30575 OLD BATON ROUGE HIGHWAY
HAMMOND LA
70403
US

IV. Provider business mailing address

PO BOX 770
ZACHARY LA
70791-0770
US

V. Phone/Fax

Practice location:
  • Phone: 225-306-2050
  • Fax: 225-567-6962
Mailing address:
  • Phone: 225-306-2000
  • Fax: 225-658-1282

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: PHD
Phone: 225-306-2000