NPIMap

Organization Active NPI

Southeast, Inc.

  • Federally Qualified Health Center (FQHC)
  • Columbus, OH
National Provider Identifier
1922406008
Registry record updated Oct 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0300 Issued in OH
Legal business name
SOUTHEAST, INC.
Practice address
524 W Broad St
Columbus, OH 43215-2775
Phone
(614) 225-0980
Fax
(614) 225-0991
NPI assigned
Dec 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2025

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) 225-0980

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0300 OH Primary

Addresses

Primary practice location

524 W Broad St
Columbus, OH 43215-2775

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0135524MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150116001258 OH Part A Provider - Federally Qualified Health Center (FQHC) 8426014853 Practice locations: Columbus, OH

Federally qualified health center certification: CCN 361060

Legal name
SOUTHEAST INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 16, 2015
Last certification
Jan 16, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 9, 1978 in OH
Enrollment address
524W Broad St
Columbus, OH 43215-2775

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

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 OfficerSecretary Jan 18, 2023
Operational/Managerial ControlBoard 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 OfficerVice President Jul 1, 2018
Sarah Lenkay Individual Corporate DirectorBoard Member Jan 18, 2023
Timothy Wheat Individual Corporate DirectorBoard Member Jan 18, 2023
Dave Lane Individual Corporate DirectorChairman 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
Don Strasser Individual Corporate DirectorBoard Member Aug 1, 2018
Kate Hamilton Individual Corporate DirectorMember at Large Jul 1, 2014
Kim Krone Individual Corporate DirectorBoard Member Feb 1, 2016
Wendy Williams Individual Corporate OfficerCoo May 5, 2025
Operational/Managerial ControlChieft Operations Officer May 5, 2025

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1417737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760832000000",
    "number": "1922406008",
    "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": "524 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432152775",
            "telephone_number": "614-225-0980",
            "fax_number": "614-225-0991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-05",
        "last_updated": "2025-10-19",
        "certification_date": "2025-10-19",
        "status": "A",
        "authorized_official_last_name": "TONG",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "614-225-0980"
    },
    "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": "0135524",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.