NPIMap

Organization Active NPI

Southeast Community Health Systems

  • Federally Qualified Health Center (FQHC)
  • Zachary, LA
National Provider Identifier
1083463871
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHEAST COMMUNITY HEALTH SYSTEMS
Practice address
205 E Flanacher Road
Zachary, LA 70791
Phone
(225) 306-2000
Fax
(225) 222-6543
NPI assigned
May 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Virginia Foster
Title
Credentialing Specialist
Phone
(225) 306-2067

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

205 E Flanacher Road
Zachary, LA 70791

Mailing address

PO Box 770
Zachary, LA 70791-0770
Phone (225) 306-2044

Other names 1

  • Southeast Community Health Systems - Port Hudson School Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250211002170 LA Part A Provider - Federally Qualified Health Center (FQHC) 4284610437 Practice locations: Zachary, LA

Federally qualified health center certification: CCN 711073

Legal name
SOUTHEAST COMMUNITY HEALTH SYSTEMS
Doing business as
SOUTHEAST COMMUNITY HEALTH SYSTEMS - PORT HUDSON SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 2025
Last certification
Jan 9, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 28, 1992 in LA
Enrollment address
205 E Flanacher Rd
Zachary, LA 70791

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 22

National Provider Directory

National Provider Directory
Tax ID family
SE Community Health Systems37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Terry Addison Individual Corporate OfficerBoard Member Jul 1, 2024
Mira L Robertson Individual Corporate OfficerBoard Member Jul 1, 2024
Theresa Bankston Individual Operational/Managerial ControlCfo Jul 1, 2024
Major Coleman Individual Corporate OfficerBoard Member Jul 1, 2024
Margaret Smith Individual Corporate OfficerBoard Member Jul 1, 2024
Michael Martin Individual Corporate OfficerBoard Vice Chair Jul 1, 2024
Alecia Cyprian Individual Corporate DirectorCeo Jul 1, 2024
Virginia Reeves Foster Individual W-2 Managing EmployeeCredentialing Specialist Jul 1, 2024
Paula McNabb Individual Corporate OfficerBoard Member Jul 1, 2024
Reyna E Lopez Individual Corporate OfficerBoard Member Jul 1, 2024
Sandy K Tillery Individual Corporate OfficerBoard Member Jul 1, 2024
Dameon Jackson Individual Corporate OfficerBoard Chair Jul 1, 2024

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
KentwoodKentwood, LA, CCN 191841 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2008
AlbanyHammond, LA, CCN 191895 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2013
IndependenceIndependence, LA, CCN 191918 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2008
WMGHammond, LA, CCN 191965 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2008

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1083463871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 770",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "707910770",
            "telephone_number": "225-306-2044",
            "fax_number": "225-658-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E FLANACHER ROAD",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "70791",
            "telephone_number": "225-306-2000",
            "fax_number": "225-222-6543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST COMMUNITY HEALTH SYSTEMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "FOSTER",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "225-306-2067"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Community Health Systems - Port Hudson School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Zachary, LA

Sources for this page

Verify at the official NPI Registry.