Healthcare Provider Details

I. General information

NPI: 1154243202
Provider Name (Legal Business Name): SOUTHEAST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3869 SOLDIER ST
COLUMBUS OH
43232-4980
US

IV. Provider business mailing address

3869 SOLDIER ST
COLUMBUS OH
43232-4980
US

V. Phone/Fax

Practice location:
  • Phone: 614-225-0990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CHARLES TONG
Title or Position: CFO
Credential:
Phone: 614-360-0103