NPIMap

Organization Active NPI

Southeast Community Health Systems

  • Federally Qualified Health Center (FQHC)
  • Zachary, LA
National Provider Identifier
1124738307
Registry record updated Nov 29, 2022
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
4100 Bronco LN
Zachary, LA 70791-3024
Phone
(225) 306-2000
Fax
(225) 658-9443
NPI assigned
Nov 29, 2022
Last updated
Nov 29, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2022

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 NU Primary

Addresses

Primary practice location

4100 Bronco LN
Zachary, LA 70791-3024

Mailing address

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

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vfoster@shchc.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250307002655 LA Part A Provider - Federally Qualified Health Center (FQHC) 4284610437 Practice locations: Zachary, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124738307. Details of each certification follow.

Federally qualified health center certification: CCN 711115

Legal name
SOUTHEAST COMMUNITY HEALTH SYSTEMS
Doing business as
SOUTHEAST COMMUNITY HEALTH SYSTEMS - ZACHARY HIGH SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 17, 2025
Last certification
Mar 17, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
4100 Bronco LN
Zachary, LA 70791-3024

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

Member organizations 1

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

Locations

4100 Bronco Ln
Zachary, LA 70791
Phone (225) 654-2776

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 Nov 1, 2022
Mira L Robertson Individual Corporate OfficerBoard Member Nov 1, 2022
Rochell Bates Individual Corporate OfficerBoard Member Nov 1, 2022
Major Coleman Individual Corporate OfficerBoard Member Nov 1, 2022
Margaret Smith Individual Corporate OfficerBoard Member Nov 1, 2022
Michael Martin Individual Corporate OfficerBoard Vice Chair Nov 1, 2022
Alecia Cyprian Individual W-2 Managing EmployeeAd;Ceo Nov 1, 2022
Virginia Reeves Foster Individual W-2 Managing EmployeeCredentialing Specialist Nov 1, 2022
Paula McNabb Individual Corporate OfficerBoard Member Nov 1, 2022
Reyna E Lopez Individual Corporate OfficerBoard Member Nov 1, 2022
Sandy K Tillery Individual Corporate OfficerBoard Member Nov 1, 2022
Dameon Jackson Individual Corporate OfficerBoard 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
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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1669680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669680000000",
    "number": "1124738307",
    "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": "4100 BRONCO LN",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "707913024",
            "telephone_number": "225-306-2000",
            "fax_number": "225-658-9443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST COMMUNITY HEALTH SYSTEMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-29",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-23",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vfoster@shchc.org",
            "affiliation": "N",
            "endpointDescription": "Coorespondence Email",
            "address_1": "4100 Bronco Ln",
            "city": "Zachary",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707913024",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Zachary, LA

Sources for this page

Verify at the official NPI Registry.