MEDICARE: CENTRAL ALABAMA KIDNEY AND HYPERTENSION CENTER, P.C.

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	207RN0300X	Nephrology Physician	10666 AND 17288	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1962592303	OTHER	AL	DR. KROTHAPALLI'S NPI
3	1841380284	OTHER		DR. VARGHESE NPI

General Provider Information

NPI Number	:	1922198373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL ALABAMA KIDNEY AND HYPERTENSION CENTER, P.C.

Provider Business Mailing Address
First Line	:	4163 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2881
Country	:	US
Telephone Number	:	334-396-5570
Fax Number	:	334-396-5572

Provider Business Practice Location Address
First Line	:	4163 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2881
Country	:	US
Telephone Number	:	334-396-5570
Fax Number	:	334-396-5572

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHIRLEY KROTHAPALLI
Credential	:
Telephone Number	:	334-396-5570

Provider Enumeration Date	:	10/14/2006
Last Update Date	:	06/21/2010

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