Provider Demographics
NPI:1497402507
Name:SOUTHEAST INC
Entity Type:Organization
Organization Name:SOUTHEAST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-360-0103
Mailing Address - Street 1:PO BOX 1809
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43216-1809
Mailing Address - Country:US
Mailing Address - Phone:614-225-0980
Mailing Address - Fax:614-225-0991
Practice Address - Street 1:37990 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WOODSFIELD
Practice Address - State:OH
Practice Address - Zip Code:43793-9247
Practice Address - Country:US
Practice Address - Phone:614-255-0990
Practice Address - Fax:614-225-0991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)