Organization
IVY CREEK OF BUTLER, LLC.
Active
Other names
Regional Medical Center Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID GLENN WILCOX CPA (INACTIVE) (CFO)
(334) 383-2423
Entity
Organization
Contact information
Practice address
125 CHURCH STREET, GEORGIANA, AL 36033
(334) 376-2291
(334) 376-3655
Mailing address
300 N COLLEGE ST, GREENVILLE, AL 36037
(334) 382-2681
(334) 383-9884
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
11769
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
540003424
—
AL
Enumeration date
02/14/2007
Last updated
06/25/2019
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