Provider Demographics
NPI:1124213228
Name:FRIENDLY CARE DIAGNOSTIC SERVICES INC
Entity Type:Organization
Organization Name:FRIENDLY CARE DIAGNOSTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SERGO
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTELIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-219-7003
Mailing Address - Street 1:3216 N TURNBULL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5732
Mailing Address - Country:US
Mailing Address - Phone:504-885-6932
Mailing Address - Fax:504-885-2987
Practice Address - Street 1:3216 N TURNBULL DR
Practice Address - Street 2:SUITE B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5732
Practice Address - Country:US
Practice Address - Phone:504-885-6932
Practice Address - Fax:504-885-2987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DA55Medicare PIN