IVYCREEK OF ELMORE LLC (NPI# 1205034428) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205034428 |
| Entity Type | Organization |
| Organization Name | IVYCREEK OF ELMORE LLC |
| Other Organization Name | ELMORE COMMUNITY HOSPITAL |
| Practice Address |
500 Hospital Dr Wetumpka AL 36092-1625 |
| Mailing Address |
Po Box 130 Wetumpka AL 36092-0003 |
| Practice Telephone | 3345674311 |
| Practice Fax Number | 3345674312 |
| Mailing Telephone | 3345674311 |
| Mailing Fax Number | 3345674312 |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2012-01-03 |
| Authorized Official Name | JAMES G FAULK (CEO) |
| Authorized Official Telephone | 3345674311 |
| Is Organization Subpart | Y |
| Parent Organization Name | IVYCREEK OF ELMORE LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 146N00000X | Emergency Medical Technician, Basic | H2601 | AL | Emergency Medical Service Providers |
| Y | 146N00000X | Emergency Medical Technician, Basic | Emergency Medical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 529905190 | 05 |
| Other Name | Type Code |
|---|---|
| ELMORE COMMUNITY HOSPITAL | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396066650 | Ivycreek of Elmore LLC | Clinic/Center | 41 Cambridge Ct, Wetumpka, AL 36093-1261 | 2010-06-21 |
| 1366565152 | Ivycreek of Elmore LLC | Preferred Provider Organization | 41 Cambridge Ct, Wetumpka, AL 36093-1261 | 2007-04-09 |
| Street Address |
500 HOSPITAL DR |
| City | WETUMPKA |
| State | AL |
| Zip Code | 36092-1625 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396342184 | Ivy Creek Specialty Care | Emergency Medicine | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2020-10-05 |
| 1467069070 | Ivy Creek Specialty Care | Anesthesiology | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2020-09-28 |
| 1275919698 | Marlene Wilson-lavalley | Nurse Practitioner | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2015-08-07 |
| 1669733895 | Ivy Creek of Elmore, LLC | Hospitalist | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2012-06-05 |
| 1396031092 | Ivy Creek of Elmore LLC | General Acute Care Hospital | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2011-06-22 |
| 1790093029 | Ivy Creek of Elmore LLC | General Acute Care Hospital | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2010-09-21 |
| 1720309982 | Ivy Creek of Elmore, LLC | Physical Medicine & Rehabilitation | 500 Hospital Dr, Suite A, Wetumpka, AL 36092-1625 | 2010-06-22 |
| 1154642684 | Ivy Creek of Elmore, LLC | Surgery | 500 Hospital Dr, Suite B, Wetumpka, AL 36092-1625 | 2010-06-18 |
| 1144547712 | Ivy Creek of Elmore, LLC | Anesthesiology | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2010-04-22 |
| 1588795942 | Ivy Creek of Elmore, LLC | General Acute Care Hospital | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2007-03-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578195525 | River Region Family Medicine, LLC | Family Medicine | 277 Huntress Street, Suite 100, Wetumpka, AL 36092 | 2020-02-07 |
| 1710548003 | 2la, LLC | Hearing Instrument Specialist | 4354 Us Highway 231, Suite A, Wetumpka, AL 36092 | 2019-06-26 |
| 1124549308 | Medi - Rides Transport LLC | Non-emergency Medical Transport (VAN) | 173 Hill Street, Suite 103, Wetumpka, AL 36092 | 2017-06-28 |
| 1538699129 | Joni Smart | Pharmacist | 4538 Us Hwy 231, Wetumpka, AL 36092 | 2017-06-15 |
| 1134396898 | Blue Ridge Chiropractic, LLC | Chiropractor | 2412 Us Hwy 231, Wetumpka, AL 36092 | 2008-05-13 |
| 1932243565 | Patricia Dianne White Mcclanahan | Psychologist | 8476 U S Hwy 231 Admh Division of Intellectual Disabili, Comprehensive Support Svcs Riv & V, Wetumpka, AL 36092 | 2007-02-16 |
| 1952472607 | Wetumpka Family Practice Pa | Family Medicine | 73970 Tallassee Hwy, Wetumpka, AL 36092 | 2006-11-13 |
| 1063429744 | Jim G Anderson | Chiropractor | 76299 Tallassee Hwy, Wetumpka, AL 36092 | 2006-08-02 |
| 1710908009 | Winn Dixie Stores Inc | Durable Medical Equipment & Medical Supplies | 5326 Hwy 231 South, Wetumpka, AL 36092 | 2006-07-21 |
| 1629011770 | Spencer J Coleman Sr. | Family Medicine | 73970 Tallassee Highway, Wetumpka, AL 36092 | 2006-06-14 |
| Find all providers in zip 36092 | ||||
| Taxonomy Code | 146N00000X |
| Grouping | Emergency Medical Service Providers |
| Classification | Emergency Medical Technician, Basic |
| A Basic EMT is an individual trained and certified to perform basic life support treatment in medical emergencies based on individual state boards. |
| Notes: Sources: Tabers Medical Dictionary and Florida EMS Clearing House. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417589268 | Jacob Michael Lezon | Emergency Medical Technician, Basic | 30501 Nevins St., Ft. Rucker, AL 36362 | 2020-02-10 |
| 1902440514 | Aaron William Laube | Emergency Medical Technician, Basic | 28 Galt Ln, Fort Rucker, AL 36362-2304 | 2019-11-06 |
| 1528615408 | Zeronica Freeman Mayo | Emergency Medical Technician, Basic | 608 Dogwood Ave, Opelika, AL 36801-7006 | 2019-08-24 |
| 1659812733 | Rebecka Nisbet | Emergency Medical Technician, Basic | Andrews Avenue Building 301, Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2017-03-09 |
| 1720493620 | Nathan Kennedy | Emergency Medical Technician, Basic | 8350 3rd Ave Unit 284, Fort Rucker, AL 36362-2039 | 2014-06-30 |
| 1477978609 | Stacey Fleming | Emergency Medical Technician, Basic | 1603 5th Ave N, Birmingham, AL 35203-1922 | 2014-02-25 |
| 1548503469 | Lindsey Taylor Mendenhall | Emergency Medical Technician, Basic | Bldg 301 Andrews Ave 1-223rd Hhc, Lyster Army Health Clinic, Fort Rucker, AL 36362 | 2013-03-28 |
| 1194065805 | Brian Joseph Butler | Emergency Medical Technician, Basic | Bulding 301 Andrews Ave., Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2013-02-18 |
| 1568718955 | Daniel Joseph Grondin | Emergency Medical Technician, Basic | Lyster Army Health Clinc, Bldg 301 Andrews Ave, Ft Rucker, AL 36362-5333 | 2012-08-03 |
| 1588922108 | Zachary Thomas Fennell | Emergency Medical Technician, Basic | Building 301, Andrews Ave., Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2012-05-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.