| Ivy Creek Of Elmore Llc | |
|
815 Jackson Trace Rd Wetumpka AL 36092-1504 | |
| (334) 567-2882 | |
| (334) 567-3361 |
| Full Name | Ivy Creek Of Elmore Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 815 Jackson Trace Rd, Wetumpka, Alabama |
| Authorized Official Name and Position | Michael D Bruce (CEO) |
| Authorized Official Contact | 3345674311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Creek Of Elmore Llc Po Box 130 Wetumpka AL 36092-0003 Ph: (334) 567-2882 | Ivy Creek Of Elmore Llc 815 Jackson Trace Rd Wetumpka AL 36092-1504 Ph: (334) 567-2882 |
| NPI Number | 1316246812 |
|---|---|
| Provider Enumeration Date | 03/23/2011 |
| Last Update Date | 04/05/2022 |
| Medicare PECOS PAC ID | 8426075508 |
|---|---|
| Medicare Enrollment ID | O20111025000353 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316246812 | NPI | - | NPPES |
| 540003434 | Medicaid | AL | |
| 013434 | Other | AL | MEDICARE |
| 01D0891738 | Other | AL | CLIA |
| 102G701614 | Other | AL | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Ronaldo V Dejesus, Md, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 74186 Tallassee Hwy, Wetumpka, AL 36092 Phone: 334-567-0346 Fax: 334-567-0855 | |
Mracek Family & Internal Medicine Clinic Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 807 Jackson Trace Rd, Wetumpka, AL 36092 Phone: 334-567-3150 Fax: 334-567-3152 | |
Ivycreek Of Elmore Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 41 Cambridge Ct, Wetumpka, AL 36093 Phone: 334-567-3309 Fax: 334-567-3361 | |
Ivy Creek Of Elmore Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 807 Jackson Trace Rd, Wetumpka, AL 36092 Phone: 334-358-3777 | |
Holtville Family Practice Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8502 Holtville Rd, Wetumpka, AL 36092 Phone: 334-399-9176 | |
Ivy Creek Of Elmore, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 525 Hospital Dr, Wetumpka, AL 36092 Phone: 334-567-5626 Fax: 334-514-3686 |