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

Doing business as

Georgiana Medical Center

Practice address

515 N Miranda Ave
Georgiana, AL 36033-4519

Phone

(334) 376-2963

Fax

(334) 376-3657

NPI assigned

Aug 5, 2006

Last updated

Mar 19, 2013By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477562783. Details of each certification follow.

• CCN 010047 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 010047

Legal name

GEORGIANA MEDICAL CENTER

Certification status

Terminated Voluntary: merger or closure, Mar 8, 2019

Provider type (POS)

Hospital – Short-term

Participating since

Jul 1, 1966

Last certification

Aug 2, 2018

Beds

22

Ownership / control type

Private (for profit)

Most recent change of ownership

Dec 1, 2012 (8 total)

Facility address

515 N Miranda Avenue
Georgiana, AL 36033

Locations

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": "MEDICARE - HOSPITAL",
            "identifier": "010047",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "010147",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H0S0047H",
            "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 (Butler Home Health)
• Owens Medical Supply LLC
• Nicole M Seale, CRNP
• Brittany Sheffield, CRNP

• General Acute Care Hospital in Georgiana, AL
• Providers in Georgiana, AL by specialty
• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.