IVY CREEK SPECIALTY CARE (NPI# 1396342184) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396342184 |
| Entity Type | Organization |
| Organization Name | IVY CREEK SPECIALTY CARE |
| Other Organization Name | IVY CREEK ER |
| Practice Address |
500 Hospital Dr Wetumpka AL 36092-1625 |
| Mailing Address |
Po Box 130 Wetumpka AL 36092-0003 |
| Practice Telephone | 3345674311 |
| Practice Fax Number | 3345143686 |
| Mailing Telephone | 3345674311 |
| Mailing Fax Number | 3345143686 |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2020-10-09 |
| Authorized Official Name | MICHAEL D BRUCE (CEO) |
| Authorized Official Telephone | 3345674311 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| IVY CREEK ANESTHESIA LAKE MARTIN | Doing Business As Name - Organization |
| Ivy Creek ER | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 201 Mariarden Rd, Dadeville, AL 368536244 | 2568257821 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750980819 | Ivy Creek Specialty Care | Emergency Medicine | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2020-10-20 |
| 1467069070 | Ivy Creek Specialty Care | Anesthesiology | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2020-09-28 |
| Street Address |
500 HOSPITAL DR |
| City | WETUMPKA |
| State | AL |
| Zip Code | 36092-1625 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467069070 | Ivy Creek Specialty Care | Anesthesiology | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2020-09-28 |
| 1275919698 | Marlene Wilson-lavalley | Nurse Practitioner | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2015-08-07 |
| 1669733895 | Ivy Creek of Elmore, LLC | Hospitalist | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2012-06-05 |
| 1396031092 | Ivy Creek of Elmore LLC | General Acute Care Hospital | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2011-06-22 |
| 1790093029 | Ivy Creek of Elmore LLC | General Acute Care Hospital | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2010-09-21 |
| 1720309982 | Ivy Creek of Elmore, LLC | Physical Medicine & Rehabilitation | 500 Hospital Dr, Suite A, Wetumpka, AL 36092-1625 | 2010-06-22 |
| 1154642684 | Ivy Creek of Elmore, LLC | Surgery | 500 Hospital Dr, Suite B, Wetumpka, AL 36092-1625 | 2010-06-18 |
| 1144547712 | Ivy Creek of Elmore, LLC | Anesthesiology | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2010-04-22 |
| 1205034428 | Ivycreek of Elmore LLC | Emergency Medical Technician, Basic | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2007-07-10 |
| 1588795942 | Ivy Creek of Elmore, LLC | General Acute Care Hospital | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2007-03-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578195525 | River Region Family Medicine, LLC | Family Medicine | 277 Huntress Street, Suite 100, Wetumpka, AL 36092 | 2020-02-07 |
| 1710548003 | 2la, LLC | Hearing Instrument Specialist | 4354 Us Highway 231, Suite A, Wetumpka, AL 36092 | 2019-06-26 |
| 1124549308 | Medi - Rides Transport LLC | Non-emergency Medical Transport (VAN) | 173 Hill Street, Suite 103, Wetumpka, AL 36092 | 2017-06-28 |
| 1538699129 | Joni Smart | Pharmacist | 4538 Us Hwy 231, Wetumpka, AL 36092 | 2017-06-15 |
| 1134396898 | Blue Ridge Chiropractic, LLC | Chiropractor | 2412 Us Hwy 231, Wetumpka, AL 36092 | 2008-05-13 |
| 1932243565 | Patricia Dianne White Mcclanahan | Psychologist | 8476 U S Hwy 231 Admh Division of Intellectual Disabili, Comprehensive Support Svcs Riv & V, Wetumpka, AL 36092 | 2007-02-16 |
| 1952472607 | Wetumpka Family Practice Pa | Family Medicine | 73970 Tallassee Hwy, Wetumpka, AL 36092 | 2006-11-13 |
| 1063429744 | Jim G Anderson | Chiropractor | 76299 Tallassee Hwy, Wetumpka, AL 36092 | 2006-08-02 |
| 1710908009 | Winn Dixie Stores Inc | Durable Medical Equipment & Medical Supplies | 5326 Hwy 231 South, Wetumpka, AL 36092 | 2006-07-21 |
| 1629011770 | Spencer J Coleman Sr. | Family Medicine | 73970 Tallassee Highway, Wetumpka, AL 36092 | 2006-06-14 |
| Find all providers in zip 36092 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740642180 | Derek Hunt | Emergency Medicine | 709 Sugar Bend Cir Sw, Madison, AL 35756-5311 | 2016-03-24 |
| 1740595362 | Thomas Kenyon Rose | Emergency Medicine | 130 Aniska Dr, Gadsden, AL 35901-9133 | 2010-08-09 |
| 1871706960 | Eric Wallace | Emergency Medicine | Paula Bldg 230, 728 Richard Arrington Blvd, Birmingham, AL 35294-0001 | 2007-05-07 |
| 1275610602 | Nilam Chiman Patel | Emergency Medicine | 2427 Glasscott Pt, Hoover, AL 35226-6323 | 2006-11-01 |
| 1306922380 | Russell Lee Page II | Emergency Medicine | 25273 Fifth Ave, Florala, AL 36422 | 2006-10-31 |
| 1518981174 | Simmons Ambulance Service | Emergency Medicine | 1956 Sawyer Dr, Monroeville, AL 36460-7984 | 2006-07-27 |
| 1205803327 | D'livro Lemat Beauchamp | Emergency Medicine | 4705 Woodmere Blvd, Montgomery, AL 36106-3078 | 2006-03-07 |
| 1740277607 | Adam Ross Nortick | Emergency Medicine | 339 Walker Chapel Plz Ste 115, Fultondale, AL 35068-3402 | 2005-10-05 |
| 1750980819 | Ivy Creek Specialty Care | Emergency Medicine | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2020-10-20 |
| 1740748821 | Fort Payne Hbp LLC | Emergency Medicine | 200 Medical Center Dr Sw, Fort Payne, AL 35968-3458 | 2019-03-07 |
| 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.