IVY CREEK OF TALLAPOOSA (NPI# 1720273303) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720273303 |
| Entity Type | Organization |
| Organization Name | IVY CREEK OF TALLAPOOSA |
| Other Organization Name | LAKE MARTIN COMMUNITY HOSPITAL |
| Practice Address |
201 Mariarden Rd Dadeville AL 36853-6244 |
| Practice Telephone | 2568257821 |
| Practice Fax Number | 2568255899 |
| Mailing Telephone | 2568257821 |
| Mailing Fax Number | 2568255899 |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2007-09-25 |
| Authorized Official Name | MRS. AGNES WAGES (ADMINISTRATOR) |
| Authorized Official Telephone | 2568257821 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NR1301X |
General Acute Care Hospital Specialization: Rural |
J115 | AL | Hospitals |
| Other Name | Type Code |
|---|---|
| LAKE MARTIN COMMUNITY HOSPITAL | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194278614 | Ivy Creek of Tallapoosa | Clinic/Center | 301 Mariarden Rd, Dadeville, AL 36853-6254 | 2016-08-02 |
| 1811169857 | Ivy Creek of Tallapoosa | Emergency Medical Technician, Basic | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2008-03-31 |
| Street Address |
201 MARIARDEN RD |
| City | DADEVILLE |
| State | AL |
| Zip Code | 36853-6244 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255303921 | Tallapoosa Ems, LLC | Ambulance | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2006-02-06 |
| 1750980819 | Ivy Creek Specialty Care | Emergency Medicine | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2020-10-20 |
| 1922440833 | Juan Carlos Latorre | Pharmacist | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2013-07-19 |
| 1376889063 | Sabrina Colley Davis | Nurse Practitioner | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2012-12-27 |
| 1659685345 | Ivy Creek of Tallapoosa LLC | Medicare Defined Swing Bed Unit | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2010-08-05 |
| 1811169857 | Ivy Creek of Tallapoosa | Emergency Medical Technician, Basic | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2008-03-31 |
| 1346305216 | Lake Martin Hospice LLC. | Hospice Care, Community Based | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2006-12-22 |
| 1962509182 | Ivy Creek Medical Equipment, LLC | Durable Medical Equipment & Medical Supplies | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2006-09-20 |
| 1598783904 | Ivy Creek of Tallapoosa, LLC | General Acute Care Hospital | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528378197 | Ivy Creek Medical Equipment, LLC | Durable Medical Equipment & Medical Supplies | 201 Mariarden Road, Dadeville, AL 36853 | 2010-10-18 |
| 1912125535 | Casey Turner | Pharmacist | 459 North Broadnax Street, Dadeville, AL 36853 | 2007-04-20 |
| 1053467100 | Anthony Leon Nix | Pharmacist | 221 E South Street, Dadeville, AL 36853 | 2007-01-25 |
| 1407879083 | Karen J Mockler | Family Medicine | 1034 South Tallassee Street, Dadeville, AL 36853 | 2006-07-25 |
| 1902947336 | Frank Langley Pearson | Pharmacist | 221 E South Street, Dadeville, AL 36853 | 2007-02-09 |
| 1194871251 | Pamela Bass Gam | Pharmacist | 221 E South Street, Dadeville, AL 36853 | 2007-01-25 |
| 1942266408 | Sridhar Krishnamurti | Audiologist | 301 Mariarden Rd, Lake Martin Community Hospital, Dadeville, AL 36853 | 2006-04-25 |
| 1124298351 | State of Alabama | Public Health or Welfare | 535 N Broadnax St, Dadeville, AL 36853-0100 | 2008-03-04 |
| 1164538203 | Robert William Bartel | General Practice | 301 Mariarden Rd, Dadeville, AL 36853-0129 | 2006-08-22 |
| 1790717858 | John Raymond Durant | General Practice | 301 Mariarden Rd, Ste D, Dadeville, AL 36853-0129 | 2006-07-07 |
| Find all providers in zip 36853 | ||||
| Taxonomy Code | 282NR1301X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Rural |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598783904 | Ivy Creek of Tallapoosa, LLC | General Acute Care Hospital | 201 Mariarden Rd, Dadeville, AL 36853-6244 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992812382 | Professional Resources Management, Inc. | General Acute Care Hospital | 102 Conecuh Ave W, Union Springs, AL 36089-1303 | 2006-08-23 |
| 1588779920 | Greene County Hospital & Nursing Home | General Acute Care Hospital | 509 Wilson Ave, Eutaw, AL 35462 | 2006-08-19 |
| 1598770943 | Gilliard Health Services | General Acute Care Hospital | 220 Hospital Dr, Jackson, AL 36545-2459 | 2006-07-31 |
| 1255376828 | The Bibb County Healthcare Authority | General Acute Care Hospital | 208 Pierson Ave, Centreville, AL 35042-2918 | 2006-06-18 |
| 1417306663 | Cullman Regional Medical Center | General Acute Care Hospital | 1912 Al Highway 157, Cullman, AL 35058-0609 | 2016-06-08 |
| 1033579024 | St. Vincent's East Family Practice | General Acute Care Hospital | 2152 Old Springville Rd, Center Point, AL 35215-4005 | 2016-03-03 |
| 1255776639 | D. W. Mcmillan Memorial Hospital | General Acute Care Hospital | 1301 Belleville Ave, Brewton, AL 36426-1306 | 2013-04-30 |
| 1922442755 | Mohamad Moustapha El Khatib | General Acute Care Hospital | 101 Fitness Way, Suite 2100, Athens, AL 35611-2480 | 2013-04-23 |
| 1770814626 | Troy Hospital Health Care Authority | General Acute Care Hospital | 1330 Highway 231 S, Troy, AL 36081-3058 | 2010-01-15 |
| 1841453644 | Citizens Baptist Medical Center | General Acute Care Hospital | 604 Stone Ave, Talladega, AL 35160-2217 | 2008-07-02 |
| 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.