NPIMap

Organization Active NPI

Ivy Creek of Tallapoosa LLC

Doing business as Lake Martin Community Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Dadeville, AL
National Provider Identifier
1659685345
Registry record updated Aug 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
H6202 Issued in AL
Legal business name
IVY CREEK OF TALLAPOOSA LLC
Doing business as
Lake Martin Community Hospital
Practice address
201 Mariarden Rd
Dadeville, AL 36853-6244
Phone
(256) 825-7821
NPI assigned
Aug 5, 2010
Last updated
Aug 21, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
IVY CREEK OF TALLAPOOSA LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 21, 2020

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

Authorized official

Name
Mr. Michael Bruce
Title
Owner/Ceo
Phone
(256) 825-7821

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X H6202 AL Primary

Addresses

Primary practice location

201 Mariarden Rd
Dadeville, AL 36853-6244

Mailing address

201 Mariarden Rd
Dadeville, AL 36853-6244
Phone (256) 825-7821

Other identifiers 2

IdentifierTypeStateIssuer
010144OtherALBC/BS
HOS0052HMedicaidAL

Other names 1

  • Lake Martin Community Hospital Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ivy Creek of Tallapoosa8 organizations share this tax ID, including this one
Part of
Ivy Creek of Tallapoosa

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597968000000",
    "number": "1659685345",
    "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": "256-825-7821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 MARIARDEN RD",
            "city": "DADEVILLE",
            "state": "AL",
            "postal_code": "368536244",
            "telephone_number": "256-825-7821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY CREEK OF TALLAPOOSA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IVY CREEK OF TALLAPOOSA LLC",
        "enumeration_date": "2010-08-05",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A",
        "authorized_official_last_name": "BRUCE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "256-825-7821",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "AL",
            "license": "H6202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "010144",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HOS0052H",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Martin Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Martin Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dadeville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; 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.