IVY CREEK OF TALLAPOOSA LLC


Address: 301 Mariarden Rd, Dadeville, AL 36853-0129
Phone: 2568253280

IVY CREEK OF TALLAPOOSA LLC (NPI# 1932130002) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1932130002
Entity Type Organization
Organization Name IVY CREEK OF TALLAPOOSA LLC
Other Organization Name LAKE MARTIN FAMILY MEDICINE
Practice Address 301 Mariarden Rd
Dadeville
AL 36853-0129
Mailing Address Po Box 129
Dadeville
AL 36853-0129
Practice Telephone 2568253280
Practice Fax Number 2568270808
Mailing Telephone 2568257871
Mailing Fax Number 2568255742
Enumeration Date 2006-07-06
Last Update Date 2013-01-08
Authorized Official Name PATTY N KERR (PRACTICE MANAGER)
Authorized Official Telephone 2568253280
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QR1300X Clinic/Center
Specialization: Rural Health
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
AL 540003420 05

Other Provider/Organization Names

Other Name Type Code
Lake Martin Family Medicine Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1659685345 Ivy Creek of Tallapoosa LLC Medicare Defined Swing Bed Unit 201 Mariarden Rd, Dadeville, AL 36853-6244 2010-08-05
1225211709 Ivy Creek of Tallapoosa LLC Home Health 301 Mariarden Rd, Suite F, Dadeville, AL 36853-6254 2007-12-07

Office Location

Street Address 301 MARIARDEN RD
City DADEVILLE
State AL
Zip Code 36853-0129

Providers in the same location

NPI Name Taxonomy Address Enumeration
1114929742 Kimberly A Robertson Nurse Practitioner 301 Mariarden Rd, Suite D, Dadeville, AL 36853-6254 2005-08-12
1508314865 Cathy Pitts Nurse Practitioner 301 Mariarden Rd, Suite D, Dadeville, AL 36853-6254 2016-09-15
1194278614 Ivy Creek of Tallapoosa Clinic/Center 301 Mariarden Rd, Dadeville, AL 36853-6254 2016-08-02
1912359100 Brian Heath Daniel Nurse Practitioner 301 Mariarden Rd, Suite D, Dadeville, AL 36853-6254 2016-07-12
1780036426 April Dye I Nurse Practitioner 301 Mariarden Rd, Suite B, Dadeville, AL 36853-6254 2016-07-06
1952634248 Laura R Daniel Nurse Practitioner 301 Mariarden Rd, Dadeville, AL 36853-6254 2009-09-17
1225211709 Ivy Creek of Tallapoosa LLC Home Health 301 Mariarden Rd, Suite F, Dadeville, AL 36853-6254 2007-12-07
1952407215 Lake Martin Pharmacy Pharmacy 301 Mariarden Rd, Suite A, Dadeville, AL 36853-6254 2006-09-15
1164538203 Robert William Bartel General Practice 301 Mariarden Rd, Dadeville, AL 36853-0129 2006-08-22
1598797656 Barbara Wilder Nurse Practitioner 301 Mariarden Rd, Dadeville, AL 36853-6254 2006-07-07
Find all providers in the same location

Providers in the same zip code

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
1124298351 State of Alabama Public Health or Welfare 535 N Broadnax St, Dadeville, AL 36853-0100 2008-03-04
1740487610 Tallapoosa County Local Education Agency (LEA) 125 N Broadnax St, Dadeville, AL 36853-1318 2007-07-02
1659301174 Frances Kahanec Bartel Family Medicine 139 E Lafayette St, Dadeville, AL 36853-1322 2006-07-03
1790803690 Robert Wm Bartel Mdpc Family Medicine 139 E Lafayette St, Dadeville, AL 36853-1322 2007-03-27
Find all providers in zip 36853

Taxonomy Information

Taxonomy Code 261QR1300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Rural Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1194278614 Ivy Creek of Tallapoosa Clinic/Center 301 Mariarden Rd, Dadeville, AL 36853-6254 2016-08-02

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1982205753 Pickens County Primary Care PC Clinic/Center 99 Commerce Avenue, Carrollton, AL 35447 2020-11-06
1952952541 Pediatric Associates of Alexander City PC Clinic/Center 21 Coosa County Road 50, Kellyton, AL 35089-1900 2019-09-25
1205309044 Boa Vida Hospital of Aberdeen, Ms LLC Clinic/Center 184 William E Hill Drive Ste C, Carrollton, AL 35447 2019-01-04
1487123915 Physicians Care of Camden LLC Clinic/Center 24b Camden Byp, Camden, AL 36726-1770 2018-11-14
1336634666 Central Pediatrics of Somerville LLC Clinic/Center 3609 Highway 67 S, Somerville, AL 35670 2018-06-28
1578060349 Ivy Creek of Elmore, LLC Clinic/Center 4412 Hogan Rd, Deatsville, AL 36022-3400 2018-04-09
1568915106 Physicians Care of Grove Hill LLC Clinic/Center 127 Clark St Ste C&d, Grove Hill, AL 36451-3050 2016-08-01
1205294428 Red Bay Hospital Outpatient Clinics LLC Clinic/Center 14490 County Line Road, Suite A, Muscle Shoals, AL 35661 2016-02-02
1972985968 Athens Limestone Pediatric Center LLC Clinic/Center 101 Fitness Way Ste 2100, Athens, AL 35611-2494 2015-06-25
1396125258 D W Mcmillan Memorial Hospital Clinic/Center 1674 Cleveland Ave, Castleberry, AL 36432 2015-06-05
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Competitor

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City DADEVILLE
Zip Code 36853

Improve Information

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Dataset Information

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.

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