IVY CREEK OF BUTLER LLC. NPI 1245372168

NPI Information

IVY CREEK OF BUTLER, LLC. is a rural health clinic center in Georgiana, AL. IVY CREEK OF BUTLER, LLC. NPI is 1245372168. The provider is registered as an organization entity type.
The provider Is Doing Business As Regional Medical Center Clinics.

The provider's business location address is:

125 CHURCH STREET
GEORGIANA, AL
ZIP 36033
Phone: (334) 376-2291
Fax: (334) 376-3655

The provider's authorized official is David Glenn Wilcox .
The authorized official title is Cfo and has the following contact phone number (334) 383-2423.

The CLIA number assigned to this NPI record is 01D2168970 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/14/2007 and was last updated on 6/25/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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