Active NPI
Southeast, Inc.
- Federally Qualified Health Center (FQHC)
- Columbus, OH
National Provider Identifier
1609284470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- License
- 0300
- Legal business name
- SOUTHEAST, INC.
- Practice address
- 595 Van Buren Dr
Columbus, OH 43223-2230 - Phone
- (614) 225-0980
- NPI assigned
- Jul 24, 2014
- Last updated
- Jan 16, 2026
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 0300 | OH | Primary |
Addresses
Primary practice location
595 Van Buren Dr
Columbus, OH 43223-2230
Mailing address
16 W Long St
Columbus, OH 43215-2815
Phone (614) 225-0990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0143703 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150729008493 | 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 1609284470. Details of each certification follow.
Federally qualified health center certification: CCN 361075
- Legal name
- SOUTHEAST INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 29, 2015
- Last certification
- Jul 29, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- Mar 9, 1978 in OH
- Enrollment address
- 595 Van Buren Dr
Columbus, OH 43223-2230
Other NPIs with the same Medicare PAC ID 15
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- Martins Ferry, OH
- NPI 1033866140
8426014853
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- Columbus, OH
- NPI 1073262481
8426014853
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- Carrollton, OH
- NPI 1265152680
8426014853
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- Woodsfield, OH
- NPI 1497402507
8426014853
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- Shadyside, OH
- NPI 1689394900
8426014853
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- New Philadelphia, OH
- NPI 1710607130
8426014853
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Columbus, OH
- NPI 1932169497
8426014853
-
- Federally Qualified Health Center (FQHC)
- Saint Clairsville, OH
- NPI 1164800165
8426014853
National Provider Directory
National Provider Directory- Tax ID family
- Southeast Inc Billing D
Other organizations with this tax ID 21
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Columbus, OH
- NPI 1073044004
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- Martins Ferry, OH
- NPI 1033866140
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- Columbus, OH
- NPI 1073262481
-
- Federally Qualified Health Center (FQHC)
- Columbus, OH
- NPI 1154243202
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- Carrollton, OH
- NPI 1265152680
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- Woodsfield, OH
- NPI 1497402507
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- Shadyside, OH
- NPI 1689394900
-
dba Southeast Healthcare
- Federally Qualified Health Center (FQHC)
- New Philadelphia, OH
- NPI 1710607130
-
- Federally Qualified Health Center (FQHC)
- Mount Gilead, OH
- NPI 1114893203
-
- Community/Behavioral Health Agency
- Saint Clairsville, OH
- NPI 1275959934
Ownership & related parties
All disclosed owners & managing parties 11
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Kori J Manus | Corporate Director | Jan 1, 2014 | |
| Thomas Burns | Corporate Officer | Feb 1, 2013 | |
| Eileen M Goodman | Corporate Director | Jan 1, 2001 | |
| Angela Fry | Corporate Officer | Jul 1, 2018 | |
| Dave Lane | Corporate Director | Sep 1, 2021 | |
| Dianne Fidelibus | Corporate Director | Jun 26, 2024 | |
| Steve Sielschott | Corporate Director | Jan 1, 2019 | |
| William F Lee | Corporate Officer | Sep 1, 2007 | |
| Charles Chiahsing Tong | Corporate Officer | May 5, 2025 | |
| Operational/Managerial Control | May 5, 2025 | ||
| Kate Hamilton | Corporate Director | Jul 1, 2014 | |
| Wendy Williams | Corporate Officer | Nov 1, 2024 |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406160000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1768521600000",
"number": "1609284470",
"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": "614-225-0990",
"fax_number": "614-225-0991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "595 VAN BUREN DR",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432232230",
"telephone_number": "614-225-0980"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHEAST, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2014-07-24",
"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": "0300",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0143703",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.