Organization
IVYCREEK OF ELMORE LLC
Active
Parent organization
IVYCREEK OF ELMORE LLC
Other names
RIVER REGION FAMILY MEDICINE
Organization subpart
Yes
Provider details
NPI number
Legal business name
IVYCREEK OF ELMORE LLC
Authorized official
MR. MICHAEL D BRUCE (CEO)
(334) 567-4311
Entity
Organization
Contact information
Practice address
41 CAMBRIDGE CT, WETUMPKA, AL 36093-1261
(334) 567-3309
(334) 567-3361
Mailing address
PO BOX 130, WETUMPKA, AL 36092-0003
(334) 567-4311
(334) 567-4312
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
305R00000X
Preferred Provider Organization
22736
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
540003434
—
AL
Enumeration date
04/09/2007
Last updated
10/01/2012
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