| Organization Name: | SOUTHEAST, INC. |
| NPI Number: | 1164800165 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVEN ATWOOD (CFO) |
| Mailing Address: | 68353 Bannock Rd Saint Clairsville |
| State: | OH US |
| Postal Code: | 439509736 |
| Phone Number: | 7406959344 |
| Fax Number: | 7406957787 |
| NPI Enumeration Date: | 05/11/2015 |
| NPI Last Update Date: | 05/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | H80CS22681 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |