IVY CREEK SPECIALTY CARE (NPI# 1750980819) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750980819 |
| Entity Type | Organization |
| Organization Name | IVY CREEK SPECIALTY CARE |
| Practice Address |
201 Mariarden Rd Dadeville AL 36853-6244 |
| Practice Telephone | 2568257821 |
| Mailing Telephone | 2568257821 |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2020-10-20 |
| Authorized Official Name | TERESA H LANGFORD (CREDENTIALING MANAGER) |
| Authorized Official Telephone | 3342832542 |
| 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 |
|---|---|
| LMCH LOCATION | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396342184 | Ivy Creek Specialty Care | Emergency Medicine | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2020-10-05 |
| 1467069070 | Ivy Creek Specialty Care | Anesthesiology | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2020-09-28 |
| Street Address |
201 MARIARDEN RD |
| City | DADEVILLE |
| State | AL |
| Zip Code | 36853-6244 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255303921 | Tallapoosa Ems, LLC | Ambulance | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2006-02-06 |
| 1922440833 | Juan Carlos Latorre | Pharmacist | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2013-07-19 |
| 1376889063 | Sabrina Colley Davis | Nurse Practitioner | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2012-12-27 |
| 1659685345 | Ivy Creek of Tallapoosa LLC | Medicare Defined Swing Bed Unit | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2010-08-05 |
| 1811169857 | Ivy Creek of Tallapoosa | Emergency Medical Technician, Basic | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2008-03-31 |
| 1720273303 | Ivy Creek of Tallapoosa | General Acute Care Hospital | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2007-09-07 |
| 1346305216 | Lake Martin Hospice LLC. | Hospice Care, Community Based | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2006-12-22 |
| 1962509182 | Ivy Creek Medical Equipment, LLC | Durable Medical Equipment & Medical Supplies | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2006-09-20 |
| 1598783904 | Ivy Creek of Tallapoosa, LLC | General Acute Care Hospital | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528378197 | Ivy Creek Medical Equipment, LLC | Durable Medical Equipment & Medical Supplies | 201 Mariarden Road, Dadeville, AL 36853 | 2010-10-18 |
| 1912125535 | Casey Turner | Pharmacist | 459 North Broadnax Street, Dadeville, AL 36853 | 2007-04-20 |
| 1053467100 | Anthony Leon Nix | Pharmacist | 221 E South Street, Dadeville, AL 36853 | 2007-01-25 |
| 1407879083 | Karen J Mockler | Family Medicine | 1034 South Tallassee Street, Dadeville, AL 36853 | 2006-07-25 |
| 1902947336 | Frank Langley Pearson | Pharmacist | 221 E South Street, Dadeville, AL 36853 | 2007-02-09 |
| 1194871251 | Pamela Bass Gam | Pharmacist | 221 E South Street, Dadeville, AL 36853 | 2007-01-25 |
| 1942266408 | Sridhar Krishnamurti | Audiologist | 301 Mariarden Rd, Lake Martin Community Hospital, Dadeville, AL 36853 | 2006-04-25 |
| 1124298351 | State of Alabama | Public Health or Welfare | 535 N Broadnax St, Dadeville, AL 36853-0100 | 2008-03-04 |
| 1164538203 | Robert William Bartel | General Practice | 301 Mariarden Rd, Dadeville, AL 36853-0129 | 2006-08-22 |
| 1790717858 | John Raymond Durant | General Practice | 301 Mariarden Rd, Ste D, Dadeville, AL 36853-0129 | 2006-07-07 |
| Find all providers in zip 36853 | ||||
| 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 |
| 1396342184 | Ivy Creek Specialty Care | Emergency Medicine | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2020-10-05 |
| 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.