| Ivy Creek Family Care Of Holtville | |
|
4412 Hogan Rd Deatsville AL 36022-3400 | |
| (334) 514-4851 | |
| (334) 543-4854 |
| Full Name | Ivy Creek Family Care Of Holtville |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 4412 Hogan Rd, Deatsville, Alabama |
| Authorized Official Name and Position | Michael D Bruce (CEO) |
| Authorized Official Contact | 3345674311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Creek Family Care Of Holtville Po Box 130 Wetumpka AL 36092-0003 Ph: (334) 514-4851 | Ivy Creek Family Care Of Holtville 4412 Hogan Rd Deatsville AL 36022-3400 Ph: (334) 514-4851 |
| NPI Number | 1578060349 |
|---|---|
| Provider Enumeration Date | 04/09/2018 |
| Last Update Date | 04/05/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578060349 | NPI | - | NPPES |
| 01D2153925 | Other | AL | CLIA |
| 1608 | Other | AL | MEDICARE B |
| 231138 | Medicaid | AL | |
| 13474 | Other | AL | MEDICARE A |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Jackson Hospital And Clinic, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2175 Us Highway 31 N, Deatsville, AL 36022 Phone: 334-568-2120 | |
Pine Level Family Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2175 Us Highway 31 N, Deatsville, AL 36022 Phone: 334-358-3777 Fax: 334-358-0026 |