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IVY CREEK OF TALLAPOOSA LLC NPI 1598783904


NPI Information

NPI: 1598783904
Provider Name: IVY CREEK OF TALLAPOOSA, LLC

Doing Business As: LAKE MARTIN COMMUNITY HOSPITAL

Classification: General Acute Care Hospital - 282NR1301X
Entity Type: Organization

Specialization: Rural

Address:
201 MARIARDEN RD
DADEVILLE, AL
ZIP 36853
Phone: (256) 825-7821
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IVY CREEK OF TALLAPOOSA, LLC is a rural general acute care hospital in Dadeville, AL. IVY CREEK OF TALLAPOOSA, LLC NPI is 1598783904. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake Martin Community Hospital.

The provider's business location address is:

201 MARIARDEN RD
DADEVILLE, AL
ZIP 36853-244
Phone: (256) 825-7821
Fax: (256) 825-5899

The provider's authorized official is Agnes C Wages .
The authorized official title is Administrator and has the following contact phone number (256) 825-7821.

The enumeration date for this NPI number is 7/17/2006 and was last updated on 7/24/2007.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1282NR1301XGeneral Acute Care HospitalRural11872ALABAMAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1HOS0052HMEDICAIDALABAMA
2BCBSOTHERALABAMABLUE CROSS BLUE SHIELD
3010052MEDICARE ID-TYPE UNSPECIFIEDALABAMA

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: 11/14/2023

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