MEDICARE: CENTRAL ALABAMA PRIMARY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1528885795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL ALABAMA PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	4163 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2881
Country	:	US
Telephone Number	:	334-819-4770
Fax Number	:	888-440-2618

Provider Business Practice Location Address
First Line	:	4163 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2881
Country	:	US
Telephone Number	:	334-819-4770
Fax Number	:	888-440-2618

Authorized Official
Title or Position	:	SOLE MEMBER/OWNER
Name	:	DR. PETER KROTHAPALLI
Credential	:	DO
Telephone Number	:	334-414-1580

Provider Enumeration Date	:	09/20/2024
Last Update Date	:	09/20/2024

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