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General NPI Number Information
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NPI Number | 1477562783
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Entity Type | Organization
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Legal Business Name | IVY CREEK OF BUTLER LLC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 515 N MIRANDA AVE
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City | GEORGIANA
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State | AL
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Zip | 36033-4519
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Country | US
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Telephone | 334-376-2963
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Fax | 334-376-3657
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Provider Business Mailing Address
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Address Line | PO BOX 548 515 NORTH MIRANDA AVENUE
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City | GEORGIANA
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State | AL
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Zip | 36033-0548
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Country | US
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Telephone | 334-376-2963
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Fax | 334-376-3657
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL D BRUCE
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Credential |
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Telephone | 334-376-2963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 11769
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License Number State | AL
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