Provider Demographics
NPI:1528885795
Name:CENTRAL ALABAMA PRIMARY CARE LLC
Entity type:Organization
Organization Name:CENTRAL ALABAMA PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KROTHAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-414-1580
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:334-819-4770
Mailing Address - Fax:888-440-2618
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:334-819-4770
Practice Address - Fax:888-440-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty