| Ivy Creek Of Elmore, Llc | |
|
525 Hospital Dr Wetumpka AL 36092-1626 | |
| (334) 567-5626 | |
| (334) 514-3686 |
| Full Name | Ivy Creek Of Elmore, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 525 Hospital Dr, Wetumpka, Alabama |
| Authorized Official Name and Position | Michael D Bruce (CEO) |
| Authorized Official Contact | 3345674311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Creek Of Elmore, Llc Po Box 130 Wetumpka AL 36092-0003 Ph: (334) 567-5626 | Ivy Creek Of Elmore, Llc 525 Hospital Dr Wetumpka AL 36092-1626 Ph: (334) 567-5626 |
| NPI Number | 1508480633 |
|---|---|
| Provider Enumeration Date | 06/04/2020 |
| Last Update Date | 06/04/2020 |
| Medicare PECOS PAC ID | 8426075508 |
|---|---|
| Medicare Enrollment ID | O20201111003025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508480633 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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