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
JESSE A LIBNICK M.D. (PHYSICIAN)
(352) 493-1741
Entity
Organization
Contact information
Practice address
1315 NW 21ST AVE, SUITE 2, CHIEFLAND, FL 32626-1977
(352) 493-1741
(352) 490-8641
Mailing address
1315 NW 21ST AVE, SUITE 2, CHIEFLAND, FL 32626-1977
(352) 493-1741
(352) 490-8641
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
ME68806
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058586600
—
FL
Enumeration date
12/06/2013
Last updated
12/06/2013
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