Organization
IVY CREEK OF ELMORE LLC
Active
Parent organization
IVY CREEK OF ELMORE LLC
Other names
IVY CREEK OF ELMORE HOSPITALIST
Organization subpart
Yes
Provider details
NPI number
Legal business name
IVY CREEK OF ELMORE LLC
Authorized official
MR. MICHAEL D BRUCE (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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01D0680545
CLIA
AL
05
—
122925
—
AL
Enumeration date
09/21/2010
Last updated
04/05/2022
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