Organization
IVY CREEK OF TALLAPOOSA LLC
Active
Organization
IVY CREEK OF TALLAPOOSA LLC
Active
Other names
Lake Martin Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D BRUCE (CEO)
(334) 567-4311
Entity
Organization
Contact information
Practice address
301 MARIARDEN RD, DADEVILLE, AL 36853-0129
(256) 825-7871
(256) 825-5742
Mailing address
PO BOX 129, DADEVILLE, AL 36853-0129
(256) 825-7871
(256) 825-5742
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01D0920584
CLIA
AL
05
—
540003420
—
AL
Enumeration date
07/06/2006
Last updated
04/05/2022
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up