Healthcare Provider Details

I. General information

NPI: 1962652180
Provider Name (Legal Business Name): MONTGOMERY CANCER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 MEDICAL CENTER PKWY SUITE 110
SELMA AL
36701-6780
US

IV. Provider business mailing address

4145 CARMICHAEL RD
MONTGOMERY AL
36106-2803
US

V. Phone/Fax

Practice location:
  • Phone: 334-872-9300
  • Fax:
Mailing address:
  • Phone: 334-273-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VENTY BUTTS
Title or Position: CEO
Credential:
Phone: 334-273-2285