IVY CREEK OF TALLAPOOSA LLC NPI 1932130002

NPI Information

IVY CREEK OF TALLAPOOSA LLC is a rural health clinic center in Dadeville, AL. IVY CREEK OF TALLAPOOSA LLC NPI is 1932130002. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake Martin Family Medicine.

The provider's business location address is:

301 MARIARDEN RD
DADEVILLE, AL
ZIP 36853-129
Phone: (256) 825-7871
Fax: (256) 825-5742

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 enumeration date for this NPI number is 7/6/2006 and was last updated on 4/5/2022.

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

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