Organization
IVY CREEK PREVENTION CENTER LLC
Active
Other names
STILLWATERS FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D BRUCE (CEO)
(256) 675-0412
Entity
Organization
Contact information
Practice address
2129 MOONBROOK DR, DADEVILLE, AL 36853-5640
(334) 514-3848
(334) 514-3686
Mailing address
PO BOX 130, WETUMPKA, AL 36092-0003
(334) 514-3848
(334) 514-3686
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
07/10/2015
Last updated
05/19/2016
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