| Southeast, Inc. | |
|
524 W Broad St Columbus OH 43215-2775 | |
| (614) 225-0980 | |
| (614) 225-0991 |
| Full Name | Southeast, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 524 W Broad St, Columbus, Ohio |
| Authorized Official Name and Position | John Bell (CFO) |
| Authorized Official Contact | 6142250980 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast, Inc. 16 W Long St Columbus OH 43215-2815 Ph: (614) 225-0980 | Southeast, Inc. 524 W Broad St Columbus OH 43215-2775 Ph: (614) 225-0980 |
| NPI Number | 1922406008 |
|---|---|
| Provider Enumeration Date | 12/05/2014 |
| Last Update Date | 12/27/2019 |
| Medicare PECOS PAC ID | 8426014853 |
|---|---|
| Medicare Enrollment ID | O20150116001258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922406008 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 0300 (Ohio) | Primary |
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