| Southeast Inc | |
|
3795 Leona Ave Shadyside OH 43947-1367 | |
| (614) 225-0991 | |
| Not Available |
| Full Name | Southeast Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3795 Leona Ave, Shadyside, Ohio |
| Authorized Official Name and Position | John Bell (CFO) |
| Authorized Official Contact | 6143600103 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Inc Po Box 1809 Columbus OH 43216-1809 Ph: (614) 225-0980 | Southeast Inc 3795 Leona Ave Shadyside OH 43947-1367 Ph: (614) 225-0991 |
| NPI Number | 1689394900 |
|---|---|
| Provider Enumeration Date | 08/29/2022 |
| Last Update Date | 08/29/2022 |
| Medicare PECOS PAC ID | 8426014853 |
|---|---|
| Medicare Enrollment ID | O20230109000918 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689394900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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