Organization
SOUTHEAST, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES TONG (CFO)
(614) 813-0177
Entity
Organization
Contact information
Practice address
68353 BANNOCK RD, SAINT CLAIRSVILLE, OH 43950-9736
(740) 695-9344
(740) 695-7787
Mailing address
16 W LONG ST, COLUMBUS, OH 43215-2815
(614) 225-0980
(614) 225-0991
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
H80CS22681
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0143997
—
OH
Enumeration date
05/11/2015
Last updated
01/16/2026
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