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2129 Moonbrook Dr Dadeville AL 36853-5640 | |
(334) 514-3848 | |
(334) 514-3686 |
Full Name | |
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Speciality | General Practice |
Location | 2129 Moonbrook Dr, Dadeville, Alabama |
Authorized Official Name and Position | Michael D Bruce (CEO) |
Authorized Official Contact | 2566750412 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 130 Wetumpka AL 36092-0003 Ph: (334) 514-3848 | 2129 Moonbrook Dr Dadeville AL 36853-5640 Ph: (334) 514-3848 |
NPI Number | 1659755577 |
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Provider Enumeration Date | 07/10/2015 |
Last Update Date | 05/19/2016 |
Identifier | Type | State | Issuer |
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1659755577 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (* (Not Available)) | Primary |
Ivy Creek Of Tallapoosa, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5958 Highway 49 S Unit K, Dadeville, AL 36853 Phone: 256-825-7871 | |