Provider Demographics
NPI:1003105644
Name:CARDIOVASCULAR INSTITUTE OF THE SHOALS PC
Entity Type:Organization
Organization Name:CARDIOVASCULAR INSTITUTE OF THE SHOALS PC
Other - Org Name:NORTHWEST ALABAMA MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-766-2310
Mailing Address - Street 1:2095 FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2751
Mailing Address - Country:US
Mailing Address - Phone:256-766-2310
Mailing Address - Fax:256-768-9956
Practice Address - Street 1:2095 FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2751
Practice Address - Country:US
Practice Address - Phone:256-766-2310
Practice Address - Fax:256-768-9956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDR6493OtherRAILROAD MEDICARE
AL128073Medicaid
AL102G705378Medicare PIN