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General NPI Number Information
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NPI Number | 1467069070
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Entity Type | Organization
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Legal Business Name | IVY CREEK SPECIALTY CARE
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 500 HOSPITAL DR
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City | WETUMPKA
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State | AL
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Zip | 36092-1625
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Country | US
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Telephone | 334-283-2542
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Fax | 342-832-3773
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Provider Business Mailing Address
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Address Line | 500 HOSPITAL DR
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City | WETUMPKA
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State | AL
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Zip | 36092-1625
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Country | US
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Telephone | 334-283-2542
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Fax | 342-832-3773
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Authorized Official
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Title or Position | CEO & AO
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Name | MR. MICHAEL D BRUCE
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Credential | OWNER / CEO
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Telephone | 334-567-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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