IVY CREEK OF ELMORE LLC (NPI# 1376879478) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376879478 |
| Entity Type | Organization |
| Organization Name | IVY CREEK OF ELMORE LLC |
| Other Organization Name | ELMORE EAR NOSE AND THROAT SPECIALIST |
| Practice Address |
53 Cambridge Court Wetumpka AL 36093 |
| Mailing Address |
Po Box 130 Wetumpka AL 36092-0003 |
| Practice Telephone | 3345679622 |
| Practice Fax Number | 3345675024 |
| Mailing Telephone | 3345143820 |
| Mailing Fax Number | 3345674312 |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2010-09-23 |
| Authorized Official Name | AMANDA N HANNON (CREDENTIALING REP) |
| Authorized Official Telephone | 3345143820 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Elmore Ear Nose and Throat Specialist | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649441650 | Ivy Creek of Elmore LLC | General Practice | 7 Cambridge Court, Wetumpka, AL 36093-1261 | 2008-03-18 |
| 1467975581 | Ivy Creek of Elmore LLC | Internal Medicine | 807 Jackson Trace Rd, Wetumpka, AL 36092-1504 | 2017-07-20 |
| 1811421886 | Ivy Creek of Elmore LLC | Surgery | 515 Hospital Dr, Suite A, Wetumpka, AL 36092-1626 | 2017-04-17 |
| 1396031092 | Ivy Creek of Elmore LLC | General Acute Care Hospital | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2011-06-22 |
| 1316246812 | Ivy Creek of Elmore LLC | Clinic/Center | 815 Jackson Trace Rd, Wetumpka, AL 36092-1504 | 2011-03-23 |
| 1790093029 | Ivy Creek of Elmore LLC | General Acute Care Hospital | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2010-09-21 |
| Street Address |
53 CAMBRIDGE COURT |
| City | WETUMPKA |
| State | AL |
| Zip Code | 36093 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699295907 | Katrina G Owes | Home Health Aide | 4037 Us Hwy 231, Wetumpka, AL 36093 | 2017-06-27 |
| 1194057554 | Wetumpka Urgent Care LLC | Clinic/Center | 11 Cambridge Drive, Wetumpka, AL 36093 | 2010-02-09 |
| 1790815249 | Wetumpka Family Dentistry PC | Clinic/Center | 4045 Hwy 231, Wetumpka, AL 36093 | 2007-03-06 |
| 1962552448 | Ronaldo V Dejesus | Internal Medicine | 41 Cambridge Court, Wetumpka, AL 36093 | 2007-01-10 |
| 1538249149 | Bobby Joseph Luster | Chiropractor | 2412 Us Highway 231, Wetumpka, AL 36093-1209 | 2006-10-17 |
| 1942349626 | David Clark Young | Dentist | 4045 Us Highway 231, Wetumpka, AL 36093-1217 | 2007-02-06 |
| 1154784403 | Pharmix Rx LLC | Pharmacy | 66 Village Loop, Wetumpka, AL 36093-1221 | 2016-04-04 |
| 1700307113 | Sabrina Jackson | Home Health Aide | 4037 Us Highway 231 Ste B, Wetumpka, AL 36093-1224 | 2017-07-06 |
| 1427326834 | Clarence Dequan Merckerson | Counselor | 4035 Us Highway 231 Ste F, Wetumpka, AL 36093-1224 | 2011-12-13 |
| 1740566918 | Youth Enhancement Services LLC | Community/Behavioral Health | 4031 Us Highway 231, Wetumpka, AL 36093-1224 | 2011-11-01 |
| Find all providers in zip 36093 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073170700 | Usa Health Physician Billing Services LLC | Otolaryngology | 5721 Usa Drive North, Hahn 1119, Mobile, AL 36608 | 2019-05-29 |
| 1669837977 | Willard Ott | Otolaryngology | 4224 Sharpsburg Dr, Mountain Brk, AL 35213-2208 | 2015-12-31 |
| 1457724346 | Bw Physician Practices, LLC | Otolaryngology | 513 Brookwood Blvd Ste 260, Birmingham, AL 35209-7844 | 2015-11-02 |
| 1881095149 | Manjunath Maskal Krishnaiah | Otolaryngology | 1808 7 Avenue South, 563 Boshell Building, Birmingham, AL 35292 | 2014-09-05 |
| 1326464066 | Ent South, PC | Otolaryngology | 1733 W Main St Ste 100, Dothan, AL 36301-1345 | 2014-03-05 |
| 1881017424 | Etowah Ear Nose & Throat, LLC | Otolaryngology | 1026 Goodyear Ave - Ste. 100b, Gadsden, AL 35903-1194 | 2014-02-03 |
| 1912341892 | Christopher Michael Clark | Otolaryngology | 48 Medical Park Dr E Ste 153, Birmingham, AL 35235-3459 | 2013-04-23 |
| 1790028199 | Patrick Ross Owens | Otolaryngology | 833 Saint Vincents Dr Ste 402, Birmingham, AL 35205 | 2013-04-03 |
| 1558622191 | Michael Latshaw | Otolaryngology | 985 9th Ave Sw Ste 101, Bessemer, AL 35022-7810 | 2012-05-30 |
| 1215257258 | Edward Ward Stevenson | Otolaryngology | 400 University Park Drive, Apt 194, Homewood, AL 35209 | 2010-06-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.