| Ivy Creek Medical Associates | |
|
73996 Tallassee Hwy Wetumpka AL 36092-7310 | |
| (334) 567-4311 | |
| Not Available |
| Full Name | Ivy Creek Medical Associates |
|---|---|
| Speciality | Clinic/Center |
| Location | 73996 Tallassee Hwy, Wetumpka, Alabama |
| Authorized Official Name and Position | Michael D Bruce (CEO) |
| Authorized Official Contact | 2566750412 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Creek Medical Associates Po Box 130 Wetumpka AL 36092-0003 Ph: (334) 567-4311 | Ivy Creek Medical Associates 73996 Tallassee Hwy Wetumpka AL 36092-7310 Ph: (334) 567-4311 |
| NPI Number | 1659055184 |
|---|---|
| Provider Enumeration Date | 06/14/2023 |
| Last Update Date | 06/14/2023 |
| Medicare PECOS PAC ID | 7012370497 |
|---|---|
| Medicare Enrollment ID | O20230901000400 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659055184 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Bipin Kumar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710939376 PECOS PAC ID: 1254413768 Enrollment ID: I20080123000391 |
| Provider Name | John Ryan Aldridge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902150089 PECOS PAC ID: 7315198199 Enrollment ID: I20121105000452 |
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