Provider Demographics
NPI:1922198373
Name:CENTRAL ALABAMA KIDNEY AND HYPERTENSION CENTER, P.C.
Entity Type:Organization
Organization Name:CENTRAL ALABAMA KIDNEY AND HYPERTENSION CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROTHAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-396-5570
Mailing Address - Street 1:4163 LOMAC ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2881
Mailing Address - Country:US
Mailing Address - Phone:334-396-5570
Mailing Address - Fax:334-396-5572
Practice Address - Street 1:4163 LOMAC ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2881
Practice Address - Country:US
Practice Address - Phone:334-396-5570
Practice Address - Fax:334-396-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10666 AND 17288207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529501990Medicaid
AL1962592303OtherDR. KROTHAPALLI'S NPI
1841380284OtherDR. VARGHESE NPI
1841380284OtherDR. VARGHESE NPI
000028665Medicare UPIN
AL051527420Medicare PIN
ALK382Medicare PIN
AL000023903Medicare PIN
ALE78912Medicare UPIN
AL1962592303OtherDR. KROTHAPALLI'S NPI