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General NPI Number Information
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NPI Number | 1972317741
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Entity Type | Organization
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Legal Business Name | IVY CREEK FAMILY CARE OF ENTERPRISE
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 6582 BOLL WEEVIL CIR STE B
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City | ENTERPRISE
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State | AL
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Zip | 36330-9424
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Country | US
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Telephone | 334-347-2027
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Fax | 334-347-2299
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | WETUMPKA
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State | AL
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Zip | 36092-0003
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Country | US
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Telephone | 334-567-4311
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Fax | 334-512-0377
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JADE LANE
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Credential |
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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