Provider Demographics
NPI:1194035055
Name:LAKE MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:LAKE MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-557-8700
Mailing Address - Street 1:7980 NW 155TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5818
Mailing Address - Country:US
Mailing Address - Phone:305-557-8700
Mailing Address - Fax:305-557-8715
Practice Address - Street 1:7980 NW 155TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5818
Practice Address - Country:US
Practice Address - Phone:305-557-8700
Practice Address - Fax:305-557-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8422261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFILE 8685OtherHCC AHCA EXEMPT