National Provider Identifier Database

IVY CREEK OF ELMORE LLC
Preferred Provider Organization

A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.


Contact Information

IVY CREEK OF ELMORE, LLC
74186 TALLASSEE HWY
WETUMPKA, AL36092-5643
Phone: 334-567-0346
Fax: 334-567-0855
Website:
Specialty Taxonomy Code
* Preferred Provider Organization 305R00000X

* Indicates primary specialty

NPI Profile & details for IVY CREEK OF ELMORE, LLC

NPI Number 1093838880
Legal business name
LBN
IVY CREEK OF ELMORE, LLC
Authorized official GORDON FAULK - (CEO)
Entity Organization
Organization subpart No
Enumeration date 04/09/2007
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • AL License #: 00011939
  • AL Medicaid: 529913110

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for IVY CREEK OF ELMORE, LLC

There are currently no reviews for IVY CREEK OF ELMORE, LLC


NPIdb - Home
v2.201