Healthcare Provider Details

I. General information

NPI: 1427092220
Provider Name (Legal Business Name): MONTGOMERY CANCER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 CARMICHAEL ROAD
MONTGOMERY AL
36106-2801
US

IV. Provider business mailing address

4145 CARMICHAEL ROAD
MONTGOMERY AL
36106-2801
US

V. Phone/Fax

Practice location:
  • Phone: 334-273-7000
  • Fax: 337-273-2386
Mailing address:
  • Phone: 334-273-7000
  • Fax: 337-273-2386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: VENTY BUTTS
Title or Position: ADMINISTRATOR
Credential:
Phone: 334-273-7000