IVY CREEK OF ELMORE, LLC (NPI# 1619098977) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619098977 |
| Entity Type | Organization |
| Organization Name | IVY CREEK OF ELMORE, LLC |
| Practice Address |
201 S Washington Street. Autaugaville AL 36003 |
| Mailing Address |
201 S Washington Street. Po Box 490 Autaugaville AL 36003 |
| Practice Telephone | 3343619919 |
| Practice Fax Number | 3343617858 |
| Mailing Telephone | 3343619919 |
| Mailing Fax Number | 3343617858 |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2018-03-29 |
| Authorized Official Name | GORDON FAULK (CEO) |
| Authorized Official Telephone | 3345674311 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 00005737 | AL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 529915130 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578060349 | Ivy Creek of Elmore, LLC | Clinic/Center | 4412 Hogan Rd, Deatsville, AL 36022-3400 | 2018-04-09 |
| 1508480633 | Ivy Creek of Elmore, LLC | Family Medicine | 525 Hospital Dr, Wetumpka, AL 36092-1626 | 2020-06-04 |
| 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 |
201 S WASHINGTON STREET. |
| City | AUTAUGAVILLE |
| State | AL |
| Zip Code | 36003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225402050 | Advanced Counseling Experts, LLC | Community/Behavioral Health | 188 N. Foster Street Suite 109, Dothan, AL 36003 | 2015-11-17 |
| 1780607598 | Joe Frank Howell | Counselor | 201 South Washington Street, Autaugaville, AL 36003 | 2006-07-25 |
| 1437365012 | Lee Carter | Family Medicine | 201 South Washington Street, Autaugaville, AL 36003 | 2007-05-14 |
| 1821396482 | Autauga Medical Clinic LLC | Family Medicine | 201 S Washington St Ste A, Autaugaville, AL 36003-2535 | 2011-03-07 |
| 1972850741 | Ivy Creek Family Care | Clinic/Center | 201 S Washington St, Autaugaville, AL 36003-2535 | 2012-08-10 |
| 1275810368 | Caver Group LLC | Pharmacy | 209 S Washington St, Autaugaville, AL 36003-2535 | 2011-11-03 |
| 1437126117 | Bruce Mcalpin Jones | Family Medicine | 203 N Taylor St, Autaugaville, AL 36003-2663 | 2006-03-02 |
| 1992727853 | Health Services Inc | Clinic/Center | 203 N Taylor St, Autaugaville, AL 36003-2663 | 2006-07-23 |
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235745571 | Rachel Kestler | Specialist | 4102 Gadiator Street, Fort Rucker, AL 36362 | 2020-09-22 |
| 1528699444 | Jackson Hospital and Clinic, Inc | Specialist | 321 Greenville Byp Ste 2, Greenville, AL 36037-3757 | 2020-01-29 |
| 1548809403 | Mizell Memorial Hospital, Inc. | Specialist | 103 E Memorial Ave Ste A, Opp, AL 36467-1746 | 2019-12-24 |
| 1013564285 | Octavia Elisa Bruce | Specialist | 808 Green Springs Hwy, Suite 124 Studio 4, Homewood, AL 35216 | 2019-08-22 |
| 1407417702 | Sasha J White | Specialist | 410 Governors Dr. Sw, Huntsville, AL 35801 | 2019-06-26 |
| 1609342088 | Vituro Health of Georgia, LLC | Specialist | 2901 2nd Ave S Ste 130, Birmingham, AL 35233-2928 | 2018-10-23 |
| 1598248205 | Almatriga Vladzetta Essex | Specialist | 1110 15th St Ste G, Tuscaloosa, AL 35401-3393 | 2018-09-09 |
| 1013428580 | Larry Dell Turner | Specialist | 600 S Court St Ste 312, Montgomery, AL 36104-4106 | 2017-10-23 |
| 1447789870 | Alexis Lindsey | Specialist | 1909 Commerce Avenue Nw, Cullman, AL 35055 | 2017-06-08 |
| 1912447210 | Neal Laye | Specialist | 29 W 3rd St, Suite B, Sylacauga, AL 35150-2480 | 2017-03-06 |
| Find all providers with the same taxonomy | ||||
| City | AUTAUGAVILLE |
| Zip Code | 36003 |
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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.