Basic Information
| Provider Information | |||||||||
| NPI: | 1619436458 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOLA EMERGENCY PHYSICIANS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 W CEDAR ST FL 4 | ||||||||
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| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325024910 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 360 S LOLA LN | ||||||||
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| City: | PAHRUMP | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890480884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548382371 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2019 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | SCOGGINS | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9548382371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.