# IVY CREEK OF ELMORE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** IVY CREEK ANESTHESIA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396031092
- **Authorized official:** MR. MIKE D BRUCE (CEO)
- **Authorized official phone:** (334) 567-4311

## Contact information

- **Practice address:** 500 HOSPITAL DR, WETUMPKA, AL 36092-1625
- **Practice address phone:** (334) 567-4311
- **Practice address fax:** (334) 567-4312
- **Mailing address:** PO BOX 130, WETUMPKA, AL 36092-0003
- **Mailing address phone:** (334) 567-4311
- **Mailing address fax:** (334) 567-4312

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | — | NULL | Yes |

## Other

- **Enumeration date:** 06/22/2011
- **Last updated:** 04/05/2022