NPIMap

Organization Active NPI

Southeast Inc

Doing business as Southeast Healthcare

  • Federally Qualified Health Center (FQHC)
  • Shadyside, OH
National Provider Identifier
1689394900
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
Doing business as
Southeast Healthcare
Practice address
3795 Leona Ave
Shadyside, OH 43947-1367
Phone
(614) 225-0991
NPI assigned
Aug 29, 2022
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 NU Primary

Addresses

Primary practice location

3795 Leona Ave
Shadyside, OH 43947-1367

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0015243MedicaidOH

Other names 1

  • Southeast Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230109000918 OH Part A Provider - Federally Qualified Health Center (FQHC) 8426014853 Practice locations: Shadyside, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689394900. Details of each certification follow.

Federally qualified health center certification: CCN 361807

Legal name
SOUTHEAST INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 5, 2023
Last certification
Jan 5, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 9, 1978 in OH
Enrollment address
3795 Leona Ave
Shadyside, OH 43947-1367

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 Inc22 organizations share this tax ID, including this one
Part of
Southeast Inc

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 16

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 May 1, 2013
Eileen M Goodman Individual Corporate DirectorBoard Member Mar 1, 2000
Tom Shanahan Individual Corporate DirectorBoard Member Jul 1, 2022
Thomas Patrick Halaiko Individual Corporate DirectorBoard Member Jul 1, 2014
Jayn Devney Individual Corporate DirectorBoard Member Nov 26, 2025
Kimberly Standfield Individual Corporate DirectorBoard Member Nov 27, 2024
Art Deleon Individual Corporate DirectorBoard Member Jun 1, 2022
Davina Hicks Individual Corporate DirectorBoard Member Dec 18, 2024
John Tresoline Individual Corporate DirectorBoard Member Dec 18, 2024
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 Control May 5, 2025
Kate Hamilton Individual Corporate DirectorBoard Member Jul 1, 2024
Wendy Williams Individual Corporate OfficerCoo Dec 1, 2024

NPI Registry JSON

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

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768521600000",
    "number": "1689394900",
    "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": "3795 LEONA AVE",
            "city": "SHADYSIDE",
            "state": "OH",
            "postal_code": "439471367",
            "telephone_number": "614-225-0991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST INC",
        "enumeration_date": "2022-08-29",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015243",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shadyside, OH

Sources for this page

Verify at the official NPI Registry.