Organization
IVY CREEK MEDICAL EQUIPMENT, LLC
Active
Other names
Ivy Creek Medical Equipment
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BRUCE (OWNER/DIRECTOR)
(256) 825-0677
Entity
Organization
Contact information
Practice address
201 MARIARDEN RD, DADEVILLE, AL 36853-6244
(256) 825-0677
(256) 827-0803
Mailing address
201 MARIARDEN RD, DADEVILLE, AL 36853-6244
(256) 825-0677
(256) 827-0803
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1307
AL
332B00000X
Durable Medical Equipment & Medical Supplies
715
AL
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009940367
—
AL
01
—
51538455
BCBS OF ALABAMA
AL
Enumeration date
09/20/2006
Last updated
02/18/2014
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