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Organization
SOUTHEASTERN INTEGRATED MEDICAL PL
Active
Organization
SOUTHEASTERN INTEGRATED MEDICAL PL
Active
Parent organization
SOUTHEASTERN INTEGRATED MEDICAL PL
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEASTERN INTEGRATED MEDICAL PL
Authorized official
MR. JESSE C BRANNEN (CHIEF OPERATING OFFICER)
(352) 224-2200
Entity
Organization
Contact information
Practice address
4881 NW 8TH AVE, SUITE 2, GAINESVILLE, FL 32605-4582
(352) 224-2486
(352) 331-6550
Mailing address
4881 NW 8TH AVE, SUITE 2, GAINESVILLE, FL 32605-4582
(352) 373-6338
(352) 373-6144
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PY6591
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058586600
—
FL
Enumeration date
07/28/2008
Last updated
07/28/2008
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