Healthcare Provider Details

I. General information

NPI: 1003105644
Provider Name (Legal Business Name): CARDIOVASCULAR INSTITUTE OF THE SHOALS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 FLORENCE BLVD
FLORENCE AL
35630-2751
US

IV. Provider business mailing address

2095 FLORENCE BLVD
FLORENCE AL
35630-2751
US

V. Phone/Fax

Practice location:
  • Phone: 256-766-2310
  • Fax: 256-768-9956
Mailing address:
  • Phone: 256-766-2310
  • Fax: 256-768-9956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: AJIT NAIDU
Title or Position: PRESIDENT
Credential: MD
Phone: 256-766-2310