Ivy Creek Medical Equipment, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

13290738 Issued in AL

Legal business name

IVY CREEK MEDICAL EQUIPMENT, LLC

Practice address

13 Cambridge CT
Wetumpka, AL 36093-1261

Phone

(334) 514-3715

Fax

(334) 567-5423

NPI assigned

Feb 21, 2014

Last updated

Feb 25, 2014By the provider in NPPES

Organization subpart

Yes

Parent organization

IVY CREEK MEDICAL EQUIPMENT, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael Bruce

Title

Owner

Phone

(256) 825-0677

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Ivy Creek Medical Equipment LLC2 organizations share this tax ID, including this one

Part of

Ivy Creek Medical Equipment LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ivy Creek Medical Equipment, LLC

  • Oxygen Equipment & Supplies (DME)
  • Dadeville, AL
  • NPI 1528378197
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393286400000",
    "number": "1386069755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 MARIARDEN RD",
            "city": "DADEVILLE",
            "state": "AL",
            "postal_code": "368536244",
            "telephone_number": "334-514-3715",
            "fax_number": "334-567-5423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 CAMBRIDGE CT",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360931261",
            "telephone_number": "334-514-3715",
            "fax_number": "334-567-5423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY CREEK MEDICAL EQUIPMENT, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IVY CREEK MEDICAL EQUIPMENT, LLC",
        "enumeration_date": "2014-02-21",
        "last_updated": "2014-02-25",
        "status": "A",
        "authorized_official_last_name": "BRUCE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "256-825-0677",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AL",
            "license": "13290738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009940367",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ALABAMA",
            "identifier": "51538455",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea Humber
• Heather K Hyde, CRNP
• Innerfit of Wetumpka, LLC
• Ivy Creek Home Health of Elmore, LLC (Ivy Creek Home Health of Elmore)
• Ivy Creek Medical Associates
• Ivy Creek of Elmore LLC (Wetumpka Family Rural Health Clinic)
• Ivy Creek of Elmore LLC (Ivy Creek Anesthesia)
• Ivy Creek of Elmore LLC (Ivy Creek Internal Medicine)
• Ivy Creek of Elmore LLC (Ivy Creek of Elmore Hospitalist)
• Ivy Creek of Elmore LLC (Armstrong General Surgery)

• Durable Medical Equipment & Medical Supplies in Wetumpka, AL
• Providers in Wetumpka, AL by specialty
• Durable Medical Equipment & Medical Supplies in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.