NPIMap

Organization Active NPI

Southeast, Inc

  • Federally Qualified Health Center (FQHC)
  • Mount Gilead, OH
National Provider Identifier
1114893203
Registry record updated Jan 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHEAST, INC
Practice address
950 Meadow Dr Ste D
Mount Gilead, OH 43338-1389
Phone
(419) 949-2000
Fax
(419) 751-7322
NPI assigned
Oct 15, 2025
Organization subpart
Yes
Parent organization
SOUTHEAST, INCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Charles Tong
Title
Cfo
Phone
(614) 813-0177

Other NPIs with the same Medicare PAC ID 15

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

Corporate family (same tax ID) 21

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

Practitioners 95

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

View all 95

Medicare participation

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

Federally qualified health center certification: CCN D21106

Medicare enrollment files
Legal name
SOUTHEAST INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 18, 2025
Last certification
Dec 18, 2025
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
950 Meadow Dr
Ste D
Mount Gilead, OH 43338-1389

All disclosed owners & managing parties 15

Medicare enrollment files

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

NameRoleSinceShare
Kori J Manus Individual Corporate OfficerTreasurer Jan 1, 2025
Eileen M Goodman Individual Corporate DirectorBoard Member Jan 1, 2025
Tom Shanahan Individual Corporate DirectorBoard Member Jan 1, 2025
Thomas Patrick Halaiko Individual Corporate DirectorBoard Member Jan 1, 2025
Jayn Devney Individual Corporate DirectorBoard Member Nov 26, 2025
Kimberly Standfield Individual Corporate DirectorBoard Member Jan 1, 2025
Art Deleon Individual Corporate DirectorBoard Member Jan 1, 2025
Davina Hicks Individual Corporate DirectorBoard Member Dec 18, 2024
John Tresoline Individual Corporate DirectorBoard Member Dec 18, 2024
Dave Lane Individual Corporate DirectorBoard Member Jan 1, 2025
Steve Sielschott Individual Corporate DirectorBoard Member Jan 1, 2025
William F Lee Individual Corporate OfficerCeo Jan 1, 2026
Charles Chiahsing Tong Individual Corporate OfficerCfo May 5, 2025
Operational/Managerial ControlCfo May 5, 2025
Kate Hamilton Individual Corporate DirectorBoard Member Jan 1, 2025
Wendy Williams Individual Corporate OfficerCoo Jan 1, 2026

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20251218003305 OH Part a Provider - Federally Qualified Health Center (FQHC) 8426014853 Practice locations: Mount Gilead, OH

National Provider Directory

National Provider Directory
Tax ID family
Southeast Inc Billing D (22 organizations share this tax ID)
Part of
Southeast Inc Billing D

Locations

243 S Main St
Cadiz, OH 43907
Phone (740) 937-2020

595 Van Buren Dr
Columbus, OH 43223
Phone (614) 293-7417

315 E Long St
Columbus, OH 43215
Phone (614) 224-6617

924 E Main St
Columbus, OH 43205
Phone (614) 360-0251

301 Walnut St
Martins Ferry, OH 43935
Phone (740) 633-2161

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

950 Meadow Dr Ste D
Mount Gilead, OH 43338-1389

Mailing address

950 Meadow Dr Ste D
Mount Gilead, OH 43338-1389
Phone (419) 949-2000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 16, 2026.

{
    "created_epoch": "1760486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768521600000",
    "number": "1114893203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 MEADOW DR STE D",
            "city": "MOUNT GILEAD",
            "state": "OH",
            "postal_code": "433381389",
            "telephone_number": "419-949-2000",
            "fax_number": "419-751-7322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 MEADOW DR STE D",
            "city": "MOUNT GILEAD",
            "state": "OH",
            "postal_code": "433381389",
            "telephone_number": "419-949-2000",
            "fax_number": "419-751-7322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST, INC",
        "enumeration_date": "2025-10-15",
        "last_updated": "2026-01-16",
        "certification_date": "2026-01-16",
        "status": "A",
        "authorized_official_last_name": "TONG",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "614-813-0177"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Gilead, OH

Sources for this page

Verify at the official NPI Registry.