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General NPI Number Information
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NPI Number | 1255762928
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN INTEGRATED MEDICAL PL
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Dates
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Enumeration Date | 12/06/2013
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 3305 SW 34TH CIR SUITE 101
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City | OCALA
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State | FL
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Zip | 34474-6616
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Country | US
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Telephone | 352-732-4438
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Fax | 352-732-0028
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Provider Business Mailing Address
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Address Line | 3305 SW 34TH CIR SUITE 101
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City | OCALA
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State | FL
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Zip | 34474-6616
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Country | US
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Telephone | 352-732-4438
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Fax | 352-732-0028
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Authorized Official
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Title or Position | PHYSICIAN
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Name | AMY E CLUNN
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Credential | M.D.
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Telephone | 352-732-4438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME86226
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License Number State | FL
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