N RAO BOORGU MD PC

Provider Demographics

• NPI: 1780641951
• Name: N RAO BOORGU MD PC
• Entity Type: Organization
• Organization Name: N RAO BOORGU MD PC
• Other - Org Name: SHOALS KIDNEY & HTN CENTER
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: NARASIMHA
• Authorized Official - Middle Name: RAO
• Authorized Official - Last Name: BOORGU
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 256-766-1401
• Mailing Address - Street 1: 422 E DR HICKS BLVD STE A
• Mailing Address - City: FLORENCE
• Mailing Address - State: AL
• Mailing Address - Zip Code: 35630-5730
• Mailing Address - Country: US
• Mailing Address - Phone: 256-766-1401
• Mailing Address - Fax: 256-766-1402
• Practice Address - Street 1: 422 E DR HICKS BLVD
• Practice Address - City: FLORENCE
• Practice Address - State: AL
• Practice Address - Zip Code: 35630-5763
• Practice Address - Country: US
• Practice Address - Phone: 256-766-1401
• Practice Address - Fax: 256-766-1402
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-04-29
• Last Update Date: 2019-05-29

Provider Licenses

State	License ID	Taxonomies
AL	20061173	207RN0300X
AL	20061174	207RN0300X
AL	20061172	207RN0300X
AL		363LF0000X
		364SA2100X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207RN0300X	Allopathic & Osteopathic Physicians	Internal Medicine	Nephrology	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	364SA2100X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Acute Care	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
SC	110131573	Other	MEDICARE RAILROAD/PALMETTO GBA - INDIVIDUAL
AL	000060570	Medicaid
MS	0118607	Medicaid
AL	102I500688	Medicaid
SC	CC6102	Other	MEDICARE RAILROAD/PALMETTO GBA - GROUP
AL	000026605	Medicaid
AL	529400760	Medicaid
AL	000000582	Medicaid
AL	0000500688	Medicaid
MS	00012106	Medicaid
MS	00122786	Medicaid
MS	05930201	Medicaid
AL	102I397202	Medicaid
AL	000076742	Medicaid
SC	110208939	Other	MEDICARE RAILROAD/PALMETTO GBA - INDIVIDUAL
AL	000037272	Medicaid
SC	110126478	Other	MEDICARE RAILROAD/PALMETTO GBA - INDIVIDUAL
SC	500011241	Other	MEDICARE RAILROAD/PALMETTO GBA - INDIVIDUAL
AL	000026605	Medicare ID - Type Unspecified
AL	000060570	Medicare ID - Type Unspecified
AL	000076742	Medicare ID - Type Unspecified
MS	0118607	Medicaid