Basic Information
| Provider Information | |||||||||
| NPI: | 1437351186 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTGOMERY CANCER CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4145 CARMICHAEL RD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361062803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342737000 | ||||||||
| FaxNumber: | 3342732386 | ||||||||
| Practice Location | |||||||||
| Address1: | 1023 MEDICAL CENTER PKWY | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SELMA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 367016780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3348729300 | ||||||||
| FaxNumber: | 3348723919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 09/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | BUTTS | ||||||||
| AuthorizedOfficialFirstName: | VENTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3342737000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 21005 | AL | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.