Ivy Creek of Butler LLC

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

11769 Issued in AL

Legal business name

IVY CREEK OF BUTLER LLC

Practice address

515 N Miranda Ave
Georgiana, AL 36033-4519

Phone

(334) 376-2963

Fax

(334) 376-3657

NPI assigned

Aug 5, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Michael D Bruce

Title

Ceo

Phone

(334) 376-2963

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Georgiana Medical Center Doing business as

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363651200000",
    "number": "1477562783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 548",
            "address_2": "515 NORTH MIRANDA AVENUE",
            "city": "GEORGIANA",
            "state": "AL",
            "postal_code": "360330548",
            "telephone_number": "334-376-2963",
            "fax_number": "334-376-3657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 N MIRANDA AVE",
            "city": "GEORGIANA",
            "state": "AL",
            "postal_code": "360334519",
            "telephone_number": "334-376-2963",
            "fax_number": "334-376-3657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY CREEK OF BUTLER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2013-03-19",
        "status": "A",
        "authorized_official_last_name": "BRUCE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-376-2963",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "AL",
            "license": "11769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "010147",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H0S0047H",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - HOSPITAL",
            "identifier": "010047",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgiana Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Georgiana Health and Rehabilitation, LLC
• Georgiana Medical Supply Inc
• Georgiana Pharmacy, LLC
• Brandon Hester, PHARMD
• Ashley Nicole Huggins, CRNP
• Ivy Creek of Butler, LLC
• Ivy Creek-Butler Home Health LLC
• Owens Medical Supply LLC
• Nicole M Seale, CRNP
• Brittany Sheffield, CRNP

• All providers in Georgiana, AL
• General Acute Care Hospital in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; 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.