| Ivy Creek Family Care | |
|
201 S Washington St Autaugaville AL 36003-2535 | |
| (334) 361-7316 | |
| (334) 361-7858 |
| Full Name | Ivy Creek Family Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 201 S Washington St, Autaugaville, Alabama |
| Authorized Official Name and Position | James Gordon Faulk (CEO) |
| Authorized Official Contact | 3343617316 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Creek Family Care Po Box 490 Autaugaville AL 36003-0490 Ph: (334) 361-7316 | Ivy Creek Family Care 201 S Washington St Autaugaville AL 36003-2535 Ph: (334) 361-7316 |
| NPI Number | 1972850741 |
|---|---|
| Provider Enumeration Date | 08/10/2012 |
| Last Update Date | 09/28/2012 |
| Medicare PECOS PAC ID | 8921257494 |
|---|---|
| Medicare Enrollment ID | O20130530000306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972850741 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Lee R Carter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437365012 PECOS PAC ID: 1456437698 Enrollment ID: I20080327000589 |
Autauga Medical Clinic Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 201 S Washington St Ste A, Autaugaville, AL 36003 Phone: 334-361-9979 Fax: 334-361-7858 | |
Autaugaville Family Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 203 N Taylor St, Autaugaville, AL 36003 Phone: 334-365-4524 Fax: 334-365-8603 |