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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