1780641951 NPI number — N RAO BOORGU MD PC

Table of content: (NPI 1780641951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780641951 NPI number — N RAO BOORGU MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
N RAO BOORGU MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780641951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
422 E DR HICKS BLVD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35630-5730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-766-1401
Provider Business Mailing Address Fax Number:
256-766-1402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 E DR HICKS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35630-5763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-766-1401
Provider Business Practice Location Address Fax Number:
256-766-1402
Provider Enumeration Date:
04/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOORGU
Authorized Official First Name:
NARASIMHA
Authorized Official Middle Name:
RAO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-766-1401

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  20061173 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: 20061174 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 20061172 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SA2100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110131573 . This is a "MEDICARE RAILROAD/PALMETTO GBA - INDIVIDUAL" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 000060570 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0118607 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102I500688 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC6102 . This is a "MEDICARE RAILROAD/PALMETTO GBA - GROUP" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 000026605 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 529400760 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000582 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000500688 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00012106 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00122786 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05930201 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102I397202 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000076742 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110208939 . This is a "MEDICARE RAILROAD/PALMETTO GBA - INDIVIDUAL" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 000037272 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110126478 . This is a "MEDICARE RAILROAD/PALMETTO GBA - INDIVIDUAL" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 500011241 . This is a "MEDICARE RAILROAD/PALMETTO GBA - INDIVIDUAL" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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