IVY CREEK OF ELMORE, LLC (NPI# 1508480633) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508480633 |
| Entity Type | Organization |
| Organization Name | IVY CREEK OF ELMORE, LLC |
| Practice Address |
525 Hospital Dr Wetumpka AL 36092-1626 |
| Mailing Address |
Po Box 130 Wetumpka AL 36092-0003 |
| Practice Telephone | 3345675626 |
| Practice Fax Number | 3345143686 |
| Mailing Telephone | 3345675626 |
| Mailing Fax Number | 3345143686 |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2020-06-04 |
| Authorized Official Name | MICHAEL D BRUCE (CEO) |
| Authorized Official Telephone | 3345674311 |
| Authorized Official Credential | DO |
| Is Organization Subpart | Y |
| Parent Organization Name | IVY CREEK OF ELMORE, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| IVY CREEK FAMILY CARE OF WETUMPKA | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578060349 | Ivy Creek of Elmore, LLC | Clinic/Center | 4412 Hogan Rd, Deatsville, AL 36022-3400 | 2018-04-09 |
| 1619098977 | Ivy Creek of Elmore, LLC | Specialist | 201 S Washington Street., Autaugaville, AL 36003 | 2007-04-03 |
| 1558868323 | Ivy Creek of Elmore, LLC | Clinic/Center | 2256 Gilmer Ave, Tallassee, AL 36078-7114 | 2018-04-09 |
| 1669733895 | Ivy Creek of Elmore, LLC | Hospitalist | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2012-06-05 |
| 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 |
| 1255533642 | Ivy Creek of Elmore, LLC | Home Health | 500 Hospital Drive, Wetumpka, AL 36092-1625 | 2007-06-05 |
| 1093838880 | Ivy Creek of Elmore, LLC | Preferred Provider Organization | 74186 Tallassee Hwy, Wetumpka, AL 36092-5643 | 2007-04-09 |
| 1588795942 | Ivy Creek of Elmore, LLC | General Acute Care Hospital | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2007-03-08 |
| Street Address |
525 HOSPITAL DR |
| City | WETUMPKA |
| State | AL |
| Zip Code | 36092-1626 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407810765 | Daniel Mayhan | Physical Therapist | 525 Hospital Dr, Wetumpka, AL 36092-1626 | 2006-04-13 |
| 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 | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578195525 | River Region Family Medicine, LLC | Family Medicine | 277 Huntress Street, Suite 100, Wetumpka, AL 36092 | 2020-02-07 |
| 1528247905 | Redland Clinic LLC | Family Medicine | 740 Us Highway 231, Wetumpka, AL 36093-1228 | 2007-11-01 |
| 1952472607 | Wetumpka Family Practice Pa | Family Medicine | 73970 Tallassee Hwy, Wetumpka, AL 36092 | 2006-11-13 |
| 1346260684 | Lee Aldrich | Family Medicine | 11 Cambridge Dr, Wetumpka, AL 36093-1258 | 2006-07-20 |
| 1629011770 | Spencer J Coleman Sr. | Family Medicine | 73970 Tallassee Highway, Wetumpka, AL 36092 | 2006-06-14 |
| 1235106543 | Willie J Chester | Family Medicine | 4452 Us Highway 231, Wetumpka, AL 36092-3328 | 2006-03-06 |
| 1497260889 | Holtville Family Practice | Family Medicine | 8502 Holtville Rd, Wetumpka, AL 36092-7664 | 2017-12-06 |
| 1356640379 | Martin Anthony Lyons Jr. | Family Medicine | 41 Cambridge Ct, Wetumpka, AL 36093-1261 | 2011-03-16 |
| 1609959261 | Pri Med Physicians Inc | Family Medicine | 4452 Us Highway 231, Wetumpka, AL 36092-3328 | 2006-10-24 |
| 1336229608 | Bruce Lamar Kent | Family Medicine | 41 Cambridge Ct, Wetumpka, AL 36093-1261 | 2006-10-17 |
| Find all providers in WETUMPKA | ||||
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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.