IVY CREEK OF ELMORE, LLC (NPI# 1558868323) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558868323 |
| Entity Type | Organization |
| Organization Name | IVY CREEK OF ELMORE, LLC |
| Other Organization Name | IVY CREEK FAMILY CARE OF TALLASSEE |
| Practice Address |
2256 Gilmer Ave Tallassee AL 36078-7114 |
| Mailing Address |
Po Box 130 Wetumpka AL 36092-0003 |
| Practice Telephone | 3342832542 |
| Mailing Telephone | 3342832542 |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2018-04-09 |
| Authorized Official Name | MICHAEL D BRUCE (CEO) |
| Authorized Official Telephone | 3345674311 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| IVY CREEK FAMILY CARE OF TALLASSEE | 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 |
| 1508480633 | Ivy Creek of Elmore, LLC | Family Medicine | 525 Hospital Dr, Wetumpka, AL 36092-1626 | 2020-06-04 |
| 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 |
2256 GILMER AVE |
| City | TALLASSEE |
| State | AL |
| Zip Code | 36078-7114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508312737 | Tallassee Urgent Care LLC | Clinic/Center | 2256 Gilmer Ave, Tallassee, AL 36078-7126 | 2016-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811286321 | Kenneth Wesley Atkins | Behavioral Analyst | 101 S Dubois, Tallassee, AL 36078 | 2011-04-05 |
| 1811089030 | Shawn Keahey | Dentist | 1608b Gilmer Avenue, Tallassee, AL 36078 | 2006-09-28 |
| 1952409088 | Randal David Herring | Chiropractor | 315 Friendship Road, Tallassee, AL 36078 | 2006-09-20 |
| 1609801133 | Alexander Robbins | Surgery | 875 Friendship Road, Cmac Suite F, Tallassee, AL 36078 | 2006-07-12 |
| 1063467447 | John H Rand | Otolaryngology | 80 Herren Hill Road, Ste D, Tallassee, AL 36078 | 2006-05-23 |
| 1073067856 | Deray Junior Williams | Nurse Practitioner | 875 Friendship Rd, Tallassee, AL 36078 | 2016-08-09 |
| 1881752996 | Charles D Mccartha | Dentist | 1608b Gilmer Avenue, Tallassee, AL 36078 | 2006-12-04 |
| 1013009315 | Tallassee Family Dentistry PCc | Dentist | 1608b Gilmer Avenue, Tallassee, AL 36078 | 2006-09-28 |
| 1538191648 | Tom Crain | Physical Therapist | 1000 Friendship Rd, Tallassee, AL 36078 | 2006-07-07 |
| 1417412081 | Collin Jones | Specialist/Technologist | 213 Godwin Rd, Tallassee, AL 36078-1129 | 2019-02-07 |
| Find all providers in zip 36078 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1205309044 | Boa Vida Hospital of Aberdeen, Ms LLC | Clinic/Center | 184 William E Hill Drive Ste C, Carrollton, AL 35447 | 2019-01-04 |
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| 1336634666 | Central Pediatrics of Somerville LLC | Clinic/Center | 3609 Highway 67 S, Somerville, AL 35670 | 2018-06-28 |
| 1578060349 | Ivy Creek of Elmore, LLC | Clinic/Center | 4412 Hogan Rd, Deatsville, AL 36022-3400 | 2018-04-09 |
| 1568915106 | Physicians Care of Grove Hill LLC | Clinic/Center | 127 Clark St Ste C&d, Grove Hill, AL 36451-3050 | 2016-08-01 |
| 1205294428 | Red Bay Hospital Outpatient Clinics LLC | Clinic/Center | 14490 County Line Road, Suite A, Muscle Shoals, AL 35661 | 2016-02-02 |
| 1972985968 | Athens Limestone Pediatric Center LLC | Clinic/Center | 101 Fitness Way Ste 2100, Athens, AL 35611-2494 | 2015-06-25 |
| 1396125258 | D W Mcmillan Memorial Hospital | Clinic/Center | 1674 Cleveland Ave, Castleberry, AL 36432 | 2015-06-05 |
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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.