NPIMap

Organization Active NPI

Southeast, Inc.

  • Federally Qualified Health Center (FQHC)
  • Saint Clairsville, OH
National Provider Identifier
1164800165
Registry record updated Jan 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
H80CS22681 Issued in OH
Legal business name
SOUTHEAST, INC.
Practice address
68353 Bannock Rd
Saint Clairsville, OH 43950-9736
Phone
(740) 695-9344
Fax
(740) 695-7787
NPI assigned
May 11, 2015
Last updated
Jan 16, 2026By the provider in NPPES
Organization subpart
No

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
Mr. Charles Tong
Title
Cfo
Phone
(614) 813-0177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X H80CS22681 OH Primary

Addresses

Primary practice location

68353 Bannock Rd
Saint Clairsville, OH 43950-9736

Mailing address

16 W Long St
Columbus, OH 43215-2815
Phone (614) 225-0980

Other identifiers 1

IdentifierTypeStateIssuer
0143997MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150817000599 OH Part A Provider - Federally Qualified Health Center (FQHC) 8426014853 Practice locations: Saint Clairsville, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164800165. Details of each certification follow.

Federally qualified health center certification: CCN 361078

Legal name
SOUTHEAST INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 24, 2015
Last certification
Aug 24, 2015
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Mar 9, 1978 in OH
Enrollment address
68353 Bannock Rd
Saint Clairsville, OH 43950-9736

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

Other organizations with this tax ID 21

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

View all 21

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 DirectorBoard Member Jan 1, 2004
Thomas Burns Individual Corporate DirectorBoard Member Feb 1, 2013
Eileen M Goodman Individual Corporate DirectorBoard Member Jan 1, 2001
Tom Shanahan Individual Corporate DirectorBoard Member Jan 18, 2023
Thomas Patrick Halaiko Individual Corporate DirectorBoard Member Jul 1, 2014
Art Deleon Individual Corporate DirectorBoard Member Jan 18, 2023
Angela Fry Individual Corporate DirectorBoard Member Jul 1, 2018
Sarah Lenkay Individual Corporate DirectorBoard Member Jan 18, 2023
Dave Lane Individual Corporate DirectorBoard Member Sep 1, 2021
Steve Sielschott Individual Corporate DirectorBoard Member Jan 1, 2019
William F Lee Individual Corporate OfficerCeo Sep 1, 2007
Charles Chiahsing Tong Individual Corporate OfficerCfo May 5, 2025
Operational/Managerial ControlCfo May 5, 2025
Kate Hamilton Individual Corporate DirectorBoard Member Jul 1, 2014
Kim Krone Individual Corporate DirectorBoard Member Feb 1, 2016
Wendy Williams Individual Corporate OfficerChief Operating Officer Dec 1, 2024
Operational/Managerial ControlChieft Operations Officer Dec 1, 2024

NPI Registry JSON

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768521600000",
    "number": "1164800165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 W LONG ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432152815",
            "telephone_number": "614-225-0980",
            "fax_number": "614-225-0991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68353 BANNOCK RD",
            "city": "SAINT CLAIRSVILLE",
            "state": "OH",
            "postal_code": "439509736",
            "telephone_number": "740-695-9344",
            "fax_number": "740-695-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-11",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "OH",
            "license": "H80CS22681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0143997",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clairsville, OH

Sources for this page

Verify at the official NPI Registry.