Provider Demographics
NPI:1093769499
Name:MED LIFE MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:MED LIFE MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOMINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-580-3897
Mailing Address - Street 1:8260 W FLAGLER ST
Mailing Address - Street 2:SUITE 2-M
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2069
Mailing Address - Country:US
Mailing Address - Phone:786-534-2584
Mailing Address - Fax:786-542-0676
Practice Address - Street 1:8260 W FLAGLER ST
Practice Address - Street 2:SUITE 2-M
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:786-534-2584
Practice Address - Fax:786-542-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5873Medicare PIN