18D1027453 CLIA NUMBER - MONTGOMERY CANCER CENTER

Laboratory Demographics

CLIA Number: 18D1027453

Facility Name: MONTGOMERY CANCER CENTER

Facility Address:
250 FOXGLOVE DR SUITE 1
MOUNT STERLING, KY
ZIP 40353
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Facility Phone Number: 859 499-1000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1568431443

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name	Field Value
CLIA Number	18D1027453
LAB Type	Physician Office
Facility Name	MONTGOMERY CANCER CENTER
Street	250 FOXGLOVE DR SUITE 1
City	MOUNT STERLING
State	KY
ZIP	40353
Phone	859 499-1000
CertificateType	4
CertificateEffectiveDate	6/30/2022
CertificateExpirationDate	6/29/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024