SOUTHEASTERN INTEGRATED MEDICAL PL NPI 1720419484

NPI Information

  • NPI: 1720419484
  • Provider Name: SOUTHEASTERN INTEGRATED MEDICAL PL
  • Classification: Physical Medicine & Rehabilitation - 2081P2900X
  • Specialization: Pain Medicine
  • Entity Type: Organization
  • Address: 1315 NW 21ST AVE
    SUITE 2
    CHIEFLAND, FL
    ZIP 32626
  • Phone: (352) 493-1741

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NPI Details

SOUTHEASTERN INTEGRATED MEDICAL PL is a pain medicine physical medicine rehabilitation in Chiefland, FL. The provider is a physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. SOUTHEASTERN INTEGRATED MEDICAL PL NPI is 1720419484. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1315 NW 21ST AVE
SUITE 2
CHIEFLAND, FL
ZIP 32626-977
Phone: (352) 493-1741
Fax: (352) 490-8641

The provider's authorized official is Jesse A Libnick .
The authorized official title is Physician and has the following contact phone number (352) 493-1741.

The enumeration date for this NPI number is 12/6/2013 and was last updated on 12/6/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12081P2900XPhysical Medicine & RehabilitationPain MedicineME68806FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1058586600MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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