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
Last updated
Jan 16, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHEAST, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 16, 2026

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

Authorized official

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

Specialties & licenses 1

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

Addresses

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

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114893203. Details of each certification follow.

Federally qualified health center certification: CCN D21106

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Southeast Inc Billing D22 organizations share this tax ID, including this one
Part of
Southeast Inc Billing D

Other organizations with this tax ID 21

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

View all 21

Locations

611 High St NW
Carrollton, OH 44615
Phone (330) 627-3954

783 Jones Ave NW
Carrollton, OH 44615
Phone (330) 627-3954

1455 S 4th St
Columbus, OH 43207
Phone (614) 444-0800

3035 W Broad St
Columbus, OH 43204
Phone (614) 272-7005

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

824 Bowtown Rd
Delaware, OH 43015
Phone (740) 369-7688

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

344 W High Ave
New Philadelphia, OH 44663
Phone (330) 339-7850

Ownership & related parties

All disclosed owners & managing parties 15

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

Practitioners & affiliated clinicians

Practitioners 90

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 90

NPI Registry JSON

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

{
    "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.