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General NPI Number Information
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NPI Number | 1427092220
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Entity Type | Organization
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Legal Business Name | MONTGOMERY CANCER CENTER, LLC
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 4145 CARMICHAEL ROAD
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City | MONTGOMERY
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State | AL
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Zip | 36106-2801
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Country | US
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Telephone | 334-273-7000
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Fax | 337-273-2386
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Provider Business Mailing Address
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Address Line | 4145 CARMICHAEL ROAD
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City | MONTGOMERY
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State | AL
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Zip | 36106-2801
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Country | US
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Telephone | 334-273-7000
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Fax | 337-273-2386
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | VENTY BUTTS
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Credential |
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Telephone | 334-273-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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