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Organization

IVY CREEK OF ELMORE, LLC

Active
Parent organization
IVY CREEK OF ELMORE, LLC
Other names
REFERENCE LAB
Organization subpart
Yes

Provider details

NPI number
Legal business name
IVY CREEK OF ELMORE, LLC
Authorized official
MICHAEL D BRUCE CEO (CEO & AO)
(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
291U00000X
Clinical Medical Laboratory
Primary

Other

Enumeration date
03/04/2021
Last updated
06/15/2021
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