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Organization
IVY CREEK SPECIALTY CARE
Active
Organization
IVY CREEK SPECIALTY CARE
Active
Other names
IVY CREEK ANESTHESIA LAKE MARTIN, Ivy Creek ER
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D BRUCE CEO (CEO)
(334) 567-4311
Entity
Organization
Contact information
Practice address
500 HOSPITAL DR, WETUMPKA, AL 36092-1625
(334) 567-4311
(334) 514-3686
Mailing address
PO BOX 130, WETUMPKA, AL 36092-0003
(334) 567-4311
(334) 514-3686
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
NULL
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
—
Other
Enumeration date
10/05/2020
Last updated
10/09/2020
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