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Southeast Community Health Systems

Organization Active NPI Federally Qualified Health Center (FQHC) · Zachary, LA

NPI 1093429474 · NPPES record last updated Jan 10, 2023

Key facts

NPI
1093429474
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
SOUTHEAST COMMUNITY HEALTH SYSTEMS
Practice address
3775 Hemlock St
Zachary, LA 70791-4454
Phone
(225) 306-2000
Fax
(225) 658-1282
NPI assigned
Jan 10, 2023
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 4

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

Other NPIs with the same Medicare PAC ID 22

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

Corporate family (same tax ID) 36

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

View all 36

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners 24

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

Federally qualified health center certification: CCN 711074

Legal name
SOUTHEAST COMMUNITY HEALTH SYSTEMS
Doing business as
SOUTHEAST COMMUNITY HEALTH SYSTEMS - ZACHARY ELEMENTARY SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 30, 2025
Last certification
Jan 30, 2025
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Enrollment address
3775 Hemlock St
Zachary, LA 70791-4454

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 Officer
Board Member		 Nov 1, 2022
Mira L Robertson
Individual 		Corporate Officer
Board Member		 Nov 1, 2022
Rochell Bates
Individual 		Corporate Officer
Board Member		 Nov 1, 2022
Major Coleman
Individual 		Corporate Officer
Board Member		 Nov 1, 2022
Margaret Smith
Individual 		Corporate Officer
Board Member		 Nov 1, 2022
Michael Martin
Individual 		Corporate Officer
Board Vice Chair		 Nov 1, 2022
Alecia Cyprian
Individual 		W-2 Managing Employee
Ad;Ceo		 Nov 1, 2022
Virginia Reeves Foster
Individual 		W-2 Managing Employee
Credentialing Specialist		 Nov 1, 2022
Paula McNabb
Individual 		Corporate Officer
Board Member		 Nov 1, 2022
Reyna E Lopez
Individual 		Corporate Officer
Board Member		 Nov 1, 2022
Sandy K Tillery
Individual 		Corporate Officer
Board Member		 Nov 1, 2022
Dameon Jackson
Individual 		Corporate Officer
Board Chair		 Nov 1, 2022

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Kentwood
Kentwood, LA · CCN 191841		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2008
Albany
Hammond, LA · CCN 191895		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2013
Independence
Independence, LA · CCN 191918		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2008
WMG
Hammond, LA · CCN 191965		 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2008

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20250307001783 LA Part a Provider - Federally Qualified Health Center (FQHC) 4284610437 Practice locations: Zachary, LA

National Provider Directory

Tax ID family
SE Community Health Systems (37 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

3775 Hemlock St
Zachary, LA 70791-4454

Mailing address

PO Box 770
Zachary, LA 70791-0770
Phone (225) 306-2067

Other names

  • Southeast Community Health Sytms - Zachary Elementary School Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address vfoster@shchc.org

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 10, 2023.

{
    "created_epoch": "1673308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1093429474",
    "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": "225-306-2067",
            "fax_number": "225-658-9443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3775 HEMLOCK ST",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "707914454",
            "telephone_number": "225-306-2000",
            "fax_number": "225-658-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST COMMUNITY HEALTH SYSTEMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-10",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-09",
        "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": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vfoster@shchc.org",
            "affiliation": "N",
            "address_1": "3775 Hemlock St",
            "city": "Zachary",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707914454",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Southeast Community Health Sytms - Zachary Elementary School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Zachary, LA

All providers in Zachary, LA · Federally Qualified Health Center (FQHC) in Louisiana

Sources for this page

Verify at the official NPI Registry.