IVYCREEK OF ELMORE LLC NPI 1396066650

NPI Information

NPI: 1396066650
Provider Name: IVYCREEK OF ELMORE LLC

Doing Business As: RIVER REGION FAMILY MEDICINE

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
41 CAMBRIDGE CT
WETUMPKA, AL
ZIP 36093
Phone: (334) 567-3309
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IVYCREEK OF ELMORE LLC is a rural health clinic center in Wetumpka, AL. IVYCREEK OF ELMORE LLC NPI is 1396066650. The provider is registered as an organization entity type.
The provider Is Doing Business As River Region Family Medicine.

The provider's business location address is:

41 CAMBRIDGE CT
WETUMPKA, AL
ZIP 36093-261
Phone: (334) 567-3309
Fax: (334) 567-3361

The provider's authorized official is Michael D Bruce .
The authorized official title is Ceo and has the following contact phone number (334) 567-4311.

The CLIA number assigned to this NPI record is 01D2186588 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/21/2010 and was last updated on 2/18/2020.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

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

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	540003434	MEDICAID	ALABAMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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