Provider Demographics
NPI:1881630788
Name:GOOD FRIENDS MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:GOOD FRIENDS MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERIOCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-220-8580
Mailing Address - Street 1:8260 W FLAGLER ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2069
Mailing Address - Country:US
Mailing Address - Phone:305-220-8580
Mailing Address - Fax:
Practice Address - Street 1:8260 W FLAGLER ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:305-220-8580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686781Medicare Oscar/Certification
FLK6728Medicare PIN