| Good Life Medical Group, Inc. | |
|
3650 South St Ste 204 Lakewood CA 90712-1521 | |
| (562) 602-8841 | |
| (562) 602-8843 |
| Full Name | Good Life Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 3650 South St, Lakewood, California |
| Authorized Official Name and Position | Peter Hugh (C.E.O.) |
| Authorized Official Contact | 5626028841 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Good Life Medical Group, Inc. 3650 South St Ste 204 Lakewood CA 90712-1521 Ph: (562) 602-8841 | Good Life Medical Group, Inc. 3650 South St Ste 204 Lakewood CA 90712-1521 Ph: (562) 602-8841 |
| NPI Number | 1316940828 |
|---|---|
| Provider Enumeration Date | 05/31/2005 |
| Last Update Date | 11/14/2010 |
| Medicare PECOS PAC ID | 0749188456 |
|---|---|
| Medicare Enrollment ID | O20031219000386 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316940828 | NPI | - | NPPES |
| GR0092320 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A6005 (California) | Primary |
| 208000000X | Pediatrics | A050818 (California) | Secondary |
| Provider Name | Peter Chiusing Hugh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316035082 PECOS PAC ID: 6901704626 Enrollment ID: I20110214000482 |
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