MEDICARE: MONTGOMERY KIDNEY SPECIALISTS, LLP

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	174400000X	Specialist

General Provider Information

NPI Number	:	1356452403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY KIDNEY SPECIALISTS, LLP

Provider Business Mailing Address
First Line	:	2034 CHESTNUT ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-1111
Country	:	US
Telephone Number	:	334-269-0212
Fax Number	:	334-269-2144

Provider Business Practice Location Address
First Line	:	2034 CHESTNUT ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-1111
Country	:	US
Telephone Number	:	334-269-0212
Fax Number	:	334-269-2144

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	RAFAEL A. LOPEZ
Credential	:	MD
Telephone Number	:	334-269-0212

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/23/2022

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