Organization
IVY CREEK OF BUTLER LLC
Active
Other names
Georgiana Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL D BRUCE (CEO)
(334) 376-2963
Entity
Organization
Contact information
Practice address
515 N MIRANDA AVE, GEORGIANA, AL 36033-4519
(334) 376-2963
(334) 376-3657
Mailing address
PO BOX 548, 515 NORTH MIRANDA AVENUE, GEORGIANA, AL 36033-0548
(334) 376-2963
(334) 376-3657
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
11769
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010047
MEDICARE - HOSPITAL
AL
01
—
010147
BLUE CROSS
AL
05
—
H0S0047H
—
AL
Enumeration date
08/05/2006
Last updated
03/19/2013
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