Provider Demographics
NPI:1851515183
Name:DRS. LOLLEY & ZIZZI AMC
Entity Type:Organization
Organization Name:DRS. LOLLEY & ZIZZI AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-387-1811
Mailing Address - Street 1:102 THOMAS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5547
Mailing Address - Country:US
Mailing Address - Phone:318-387-1811
Mailing Address - Fax:318-387-7529
Practice Address - Street 1:102 THOMAS RD STE 203
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5547
Practice Address - Country:US
Practice Address - Phone:318-387-1811
Practice Address - Fax:318-387-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010612173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4355809970OtherBLUE CROSS
LA1136361Medicaid
LA5K313B159Medicare ID - Type Unspecified
LA4355809970OtherBLUE CROSS