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Organization
IVY CREEK SPECIALTY CARE
Active
Organization
IVY CREEK SPECIALTY CARE
Active
Other names
LMCH LOCATION
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA H LANGFORD (CREDENTIALING MANAGER)
(334) 283-2542
Entity
Organization
Contact information
Practice address
201 MARIARDEN RD, DADEVILLE, AL 36853-6244
(256) 825-7821
Mailing address
201 MARIARDEN RD, DADEVILLE, AL 36853-6244
(256) 825-7821
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
10/20/2020
Last updated
10/20/2020
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