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NPI Code Detail

MEDICARE: SOUTHEAST INC

MEDICARE: SOUTHEAST INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073262481
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST INC
Provider Business Mailing Address
First Line : PO BOX 1809
Second Line :
City : COLUMBUS
State : OH
Zip : 43216-1809
Country : US
Telephone Number : 614-225-0980
Fax Number : 614-225-0991
Provider Business Practice Location Address
First Line : 1455 S 4TH ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1011
Country : US
Telephone Number : 614-225-0980
Fax Number : 614-225-0991
Authorized Official
Title or Position : CFO
Name : CHARLES TONG
Credential :
Telephone Number : 614-813-0177
Provider Enumeration Date : 03/22/2022
Last Update Date : 01/16/2026

Similar Medicare Providers

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1124364401 — BETHANY L REINER RN, CNP
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1730540691 — MRS. DONNA CARSON RN
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1902357973 — JACQUELYN LAVENDER LCDC III
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1455 S 4TH ST
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1073044004 — SOUTHEAST COMMUNITY MENTAL HEALTH CENTER
Practice Location Address:
1455 S 4TH ST
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1497286298 — MR. DANIEL JOHN CUCIAK PCC-S, LICDC
Practice Location Address:
1455 S 4TH ST
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Directions to “SOUTHEAST INC ” Practice Location

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