Organization
IVY CREEK OF TALLAPOOSA, LLC
Active
Parent organization
IVY CREEK OF TALLAPOOSA, LLC
Other names
REFERENCE LAB
Organization subpart
Yes
Provider details
NPI number
Legal business name
IVY CREEK OF TALLAPOOSA, LLC
Authorized official
MICHAEL D BRUCE CEO & AO (CEO)
(334) 567-4311
Entity
Organization
Contact information
Practice address
201 MARIARDEN ROAD, DADEVILLE, AL 36853
(256) 825-7821
Mailing address
PO BOX 130, WETUMPKA, AL 36092-0003
(334) 283-2542
(334) 283-2377
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
05/10/2021
Last updated
04/05/2022
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