Organization
IVY CREEK OF ELMORE, LLC
Active
Other names
ELMORE COMMUNITY HOSPITAL
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D. BRUCE CEO (CEO)
(334) 567-4311
Entity
Organization
Contact information
Practice address
500 HOSPITAL DR, WETUMPKA, AL 36092-1625
(334) 567-4311
(334) 567-4312
Mailing address
PO BOX 130, WETUMPKA, AL 36092-0003
(334) 567-4311
(334) 567-4312
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
11797
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010-028
HOSPITAL BCBS OF ALABAMA
AL
01
—
010-028
BCBS OF ALABAMA
—
01
—
01D0680545
CLIA
AL
05
—
HOS0097H
—
AL
Enumeration date
03/08/2007
Last updated
04/05/2022
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