Organization
BOL MEDICAL L.L.C.
Active
Organization
BOL MEDICAL L.L.C.
Active
Other names
Bol Medical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AJSA NIKOLIC M.D. (OWNER)
(504) 837-4208
Entity
Organization
Contact information
Practice address
900 MAGAZINE ST, NEW ORLEANS, LA 70130-3814
(504) 309-0534
Mailing address
900 MAGAZINE ST, NEW ORLEANS, LA 70130-3814
(504) 309-0534
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QE0002X
Emergency Care Clinic/Center
LA 025945
LA
261QM1300X
Multi-Specialty Clinic/Center
LA 025945
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1140406
—
LA
01
—
5CQ53
MEDICARE GROUP NO
LA
01
—
LA025945
LICENCE
LA
Enumeration date
01/16/2007
Last updated
03/07/2023
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