Organization Name: | IVY CREEK OF TALLAPOOSA LLC |
NPI Number: | 1932130002 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PATTY N KERR (PRACTICE MANAGER) |
Mailing Address: | 301 Mariarden Rd Dadeville |
State: | AL US |
Postal Code: | 368530129 |
Phone Number: | 2568253280 |
Fax Number: | 2568270808 |
NPI Enumeration Date: | 07/06/2006 |
NPI Last Update Date: | 01/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |