Provider Demographics
NPI:1407085459
Name:SOUTHEAST COMMUNITY HEALTH SYSTEMS
Entity Type:Organization
Organization Name:SOUTHEAST COMMUNITY HEALTH SYSTEMS
Other - Org Name:SOUTHEAST COMMUNITY HEALTH SYSTEMS @ MIDDLE SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CYPRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:225-222-6059
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-0770
Mailing Address - Country:US
Mailing Address - Phone:225-306-2000
Mailing Address - Fax:225-658-1282
Practice Address - Street 1:1590 HWY 1042
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:LA
Practice Address - Zip Code:70441
Practice Address - Country:US
Practice Address - Phone:225-222-6293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1815543Medicaid