01D1055600 CLIA NUMBER - MONTGOMERY CANCER CENTER - PRATTVILLE

Laboratory Demographics

  • CLIA Code: 01D1055600
  • Facility Name: MONTGOMERY CANCER CENTER - PRATTVILLE
  • Facility Address: 645 MCQUEEN SMITH ROAD SUITE 207
    PRATTVILLE, AL
    ZIP 36066
  • Facility Phone: 334 351-1004
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. SAMUEL G. BORAK
  • NPI Number: 1720288632
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 01D1055600
LAB Type Physician Office
Facility Name MONTGOMERY CANCER CENTER - PRATTVILLE
Street 645 MCQUEEN SMITH ROAD SUITE 207
City PRATTVILLE
State AL
ZIP 36066
Phone 334 351-1004
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Physician Office
Lab Director DR. SAMUEL G. BORAK

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This page was last updated on: 9/29/2025