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
3304 SW 34TH CIR, OCALA, FL 34474-3358
(352) 732-4438
(352) 291-0231
Mailing address
4881 NW 8TH AVENUE, STE 2, GAINESVILLE, FL 32605-4582
(352) 373-6338
(352) 373-6144
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058586600
—
FL
Enumeration date
02/17/2009
Last updated
02/17/2009
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