| Southeastern Integrated Medical Pl | |
|
4881 Nw 8th Ave Suite 2 Gainesville FL 32605-4582 | |
| (352) 224-2486 | |
| (352) 331-6550 |
| Full Name | Southeastern Integrated Medical Pl |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4881 Nw 8th Ave, Gainesville, Florida |
| Authorized Official Name and Position | Jesse C Brannen (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 3522242200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Integrated Medical Pl 4881 Nw 8th Ave Suite 2 Gainesville FL 32605-4582 Ph: (352) 373-6338 | Southeastern Integrated Medical Pl 4881 Nw 8th Ave Suite 2 Gainesville FL 32605-4582 Ph: (352) 224-2486 |
| NPI Number | 1093970162 |
|---|---|
| Provider Enumeration Date | 07/28/2008 |
| Last Update Date | 07/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093970162 | NPI | - | NPPES |
| 058586600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | PY6591 (Florida) | Primary |
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