IVY CREEK OF ELMORE, LLC NPI 1093838880

Preferred Provider Organization in Wetumpka, AL

NPI 1093838880 Organization Preferred Provider Organization

About IVY CREEK OF ELMORE, LLC

Ivy Creek Of Elmore, Llc is a provider established in Wetumpka, Alabama specializing in preferred provider organization. The NPI number of Ivy Creek Of Elmore, Llc is 1093838880 and was assigned on April 2007. The practitioner's primary taxonomy code is 305R00000X with license number 00011939 (AL). The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Gordon Faulk (Ceo)

NPI

1093838880

Provider NameIVY CREEK OF ELMORE, LLC
Provider Location Address74186 TALLASSEE HWY WETUMPKA, AL 36092
Provider Mailing Address500 HOSPITAL DR WETUMPKA, AL 36092
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date04-09-2007
Last Update Date08-22-2020


Primary Taxonomy

Taxonomy Code305R00000X
ClassificationPreferred Provider Organization
TypeManaged Care Organizations
License No.00011939
License StateAL
Taxonomy DescriptionA 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.

Business Address

IVY CREEK OF ELMORE, LLC
74186 TALLASSEE HWY
WETUMPKA, AL
ZIP 36092
Phone: (334) 567-0346
Fax: (334) 567-0855

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Mailing Address

IVY CREEK OF ELMORE, LLC
500 HOSPITAL DR
WETUMPKA, AL
ZIP 36092
Phone: (334) 567-4311
Fax: (334) 567-3361



Authorized Official

Authorized Official Name GORDON FAULK
Authorized Official TitleCEO
Authorized Official Phone(334) 567-4311

Other Providers at the same location


The following 5 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1093865578RONALDO V DEJESUS, MD, PC
Organization
Internal Medicine74186 TALLASSEE HWY
WETUMPKA, AL 36092
(334) 567-0346
1578759668TOMMY W GARNETT DPM
Organization
Podiatrist74186 TALLASSEE HWY SUITE A
WETUMPKA, AL 36092
(334) 514-6922
1235327503WETUMPKA HOSPITALISTS, P.C.
Organization
Hospitalist74186 TALLASSEE HWY
WETUMPKA, AL 36092
(334) 315-0420
1376831610SOUTHEASTERN BALANCE CENTERS LLC
Organization
Podiatrist74186 TALLASSEE HWY SUITE A
WETUMPKA, AL 36092
(334) 514-6922
1548301914GRACE PEDIATRICS, LLC
Organization
Pediatrics74186 TALLASSEE HWY SUITE B
WETUMPKA, AL 36092
(334) 567-0346

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.