Healthcare Provider Details

I. General information

NPI: 1679624530
Provider Name (Legal Business Name): BOL MEDICAL L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAGAZINE ST
NEW ORLEANS LA
70130-3814
US

IV. Provider business mailing address

900 MAGAZINE ST
NEW ORLEANS LA
70130-3814
US

V. Phone/Fax

Practice location:
  • Phone: 504-309-0534
  • Fax:
Mailing address:
  • Phone: 504-309-0534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberLA 025945
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberLA 025945
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AJSA NIKOLIC
Title or Position: OWNER
Credential: M.D.
Phone: 504-837-4208