NPIMap

Organization Active NPI

Southeast, Inc.

  • Federally Qualified Health Center (FQHC)
  • Columbus, OH
National Provider Identifier
1194002857
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
H80CS22681-01-00 Issued in OH
Legal business name
SOUTHEAST, INC.
Practice address
16 W Long St
Columbus, OH 43215-2815
Phone
(614) 225-0980
Fax
(614) 225-0986
NPI assigned
Nov 9, 2011
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
Charles Tong
Title
Cfo
Phone
(614) 813-0177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X H80CS22681-01-00 OH Primary

Addresses

Primary practice location

16 W Long St
Columbus, OH 43215-2815

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0065539MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120119000705 OH Part A Provider - Federally Qualified Health Center (FQHC) 8426014853 Practice locations: Columbus, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194002857. Details of each certification follow.

Federally qualified health center certification: CCN 361984

Legal name
SOUTHEAST INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 20, 2012
Last certification
Jan 20, 2012
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 9, 1978 in OH
Enrollment address
16 W Long St
Columbus, OH 43215-2815

Other NPIs with the same Medicare PAC ID 15

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

  • Southeast Inc

    dba Southeast Healthcare

    • Federally Qualified Health Center (FQHC)
    • Martins Ferry, OH
    • NPI 1033866140

    8426014853

    Same PAC ID
  • Southeast Inc

    dba Southeast Healthcare

    • Federally Qualified Health Center (FQHC)
    • Columbus, OH
    • NPI 1073262481

    8426014853

    Same PAC ID
  • Southeast Inc

    dba Southeast Healthcare

    • Federally Qualified Health Center (FQHC)
    • Carrollton, OH
    • NPI 1265152680

    8426014853

    Same PAC ID
  • Southeast Inc

    dba Southeast Healthcare

    • Federally Qualified Health Center (FQHC)
    • Woodsfield, OH
    • NPI 1497402507

    8426014853

    Same PAC ID
  • Southeast Inc

    dba Southeast Healthcare

    • Federally Qualified Health Center (FQHC)
    • Shadyside, OH
    • NPI 1689394900

    8426014853

    Same PAC ID
  • Southeast Inc

    dba Southeast Healthcare

    • Federally Qualified Health Center (FQHC)
    • New Philadelphia, OH
    • NPI 1710607130

    8426014853

    Same PAC ID
  • Southeast, Inc
    • Federally Qualified Health Center (FQHC)
    • Mount Gilead, OH
    • NPI 1114893203

    8426014853

    Same PAC ID
  • Southeast, Inc
    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Columbus, OH
    • NPI 1932169497

    8426014853

    Same PAC ID
  • Southeast, Inc.
    • Federally Qualified Health Center (FQHC)
    • Saint Clairsville, OH
    • NPI 1164800165

    8426014853

    Same PAC ID
  • Southeast, Inc.
    • Federally Qualified Health Center (FQHC)
    • Delaware, OH
    • NPI 1326688334

    8426014853

    Same PAC ID
  • Southeast, Inc.
    • Federally Qualified Health Center (FQHC)
    • Columbus, OH
    • NPI 1407491566

    8426014853

    Same PAC ID
  • Southeast, Inc.
    • Federally Qualified Health Center (FQHC)
    • Cadiz, OH
    • NPI 1497292775

    8426014853

    Same PAC ID
View all 15

National Provider Directory

National Provider Directory
Tax ID family
Southeast Inc22 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 17

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 DirectorTreasurer Jan 1, 2004 7.14%
Eileen M Goodman Individual Corporate OfficerSecretary Jan 18, 2023
Corporate DirectorBoard Member Jan 1, 2001 7.14%
Tom Shanahan Individual Corporate DirectorBoard Member Jan 18, 2023
Thomas Patrick Halaiko Individual Corporate DirectorBoard Member Jul 1, 2014 7.14%
Jayn Devney Individual Corporate DirectorBoard Member Nov 26, 2025
Kimberly Standfield Individual Corporate OfficerBoard Member Nov 27, 2024
Art Deleon Individual Corporate DirectorBoard Member Jan 18, 2023
Davina Hicks Individual Corporate DirectorBoard Member Dec 18, 2024
John Tresoline Individual Corporate DirectorBoard Member Dec 18, 2024
Sarah Lenkay Individual Corporate DirectorBoard Member Jan 18, 2023
Dave Lane Individual Corporate OfficerChairman Sep 1, 2021
Dianne Fidelibus Individual Corporate DirectorBoard Member Jun 26, 2024
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 DirectorMember at Large Jul 1, 2014
Wendy Williams Individual Corporate OfficerChief Operating Officer Nov 1, 2024

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": "1320796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768521600000",
    "number": "1194002857",
    "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": "614-225-0986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 W LONG ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432152815",
            "telephone_number": "614-225-0980",
            "fax_number": "614-225-0986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-09",
        "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": "OH",
            "license": "H80CS22681-01-00",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0065539",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.