Healthcare Provider Details

I. General information

NPI: 1831296672
Provider Name (Legal Business Name): MONTGOMERY CANCER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 CARMICHAEL RD STE A
MONTGOMERY AL
36106-2803
US

IV. Provider business mailing address

4145 CARMICHAEL RD STE A
MONTGOMERY AL
36106-2803
US

V. Phone/Fax

Practice location:
  • Phone: 334-273-2281
  • Fax: 334-386-2936
Mailing address:
  • Phone: 334-273-2281
  • Fax: 334-368-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number111763
License Number StateAL

VIII. Authorized Official

Name: LISA HARRISON
Title or Position: DIR OF PHCY
Credential: RPH
Phone: 334-273-2252