Basic Information
| Provider Information | |||||||||
| NPI: | 1750838686 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEAST COMMUNITY HEALTH SYSTEMS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 770 | ||||||||
| Address2: | |||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707910770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253062000 | ||||||||
| FaxNumber: | 2256581282 | ||||||||
| Practice Location | |||||||||
| Address1: | 8913 BLUEBONNET BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708102974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256123900 | ||||||||
| FaxNumber: | 2256123800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2016 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | CYPRIAN | ||||||||
| AuthorizedOfficialFirstName: | ALECIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2253062010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.