NPIMap

Organization Active NPI

Southeastern Integrated Medical PL

  • Mental Health Counselor
  • Gainesville, FL
National Provider Identifier
1093970162
Registry record updated Jul 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
PY6591 Issued in FL
Legal business name
SOUTHEASTERN INTEGRATED MEDICAL PL
Practice address
4881 NW 8TH Ave
Suite 2
Gainesville, FL 32605-4582
Phone
(352) 224-2486
Fax
(352) 331-6550
NPI assigned
Jul 28, 2008
Organization subpart
Yes
Parent organization
SOUTHEASTERN INTEGRATED MEDICAL PLAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jesse C Brannen
Title
Chief Operating Officer
Phone
(352) 224-2200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X PY6591 FL Primary

Addresses

Primary practice location

4881 NW 8TH Ave
Suite 2
Gainesville, FL 32605-4582

Mailing address

4881 NW 8TH Ave
Suite 2
Gainesville, FL 32605-4582
Phone (352) 373-6338

Other identifiers 1

IdentifierTypeStateIssuer
058586600MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Southeastern Integrated Medical PL5 organizations share this tax ID, including this one
Part of
Southeastern Integrated Medical PL

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217203200000",
    "number": "1093970162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 NW 8TH AVE",
            "address_2": "SUITE 2",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054582",
            "telephone_number": "352-373-6338",
            "fax_number": "352-373-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 NW 8TH AVE",
            "address_2": "SUITE 2",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054582",
            "telephone_number": "352-224-2486",
            "fax_number": "352-331-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN INTEGRATED MEDICAL PL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEASTERN INTEGRATED MEDICAL PL",
        "enumeration_date": "2008-07-28",
        "last_updated": "2008-07-28",
        "status": "A",
        "authorized_official_last_name": "BRANNEN",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "352-224-2200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "PY6591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058586600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.