Ivy Creek Prevention Center LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

IVY CREEK PREVENTION CENTER LLC

Doing business as

Stillwaters Family Medicine

Practice address

2129 Moonbrook Dr
Dadeville, AL 36853-5640

Phone

(334) 514-3848

Fax

(334) 514-3686

NPI assigned

Jul 10, 2015

Last updated

May 19, 2016By 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

Michael D Bruce

Title

Ceo

Phone

(256) 675-0412

Specialties & licenses 1

Addresses

Other names 1

• STILLWATERS FAMILY MEDICINE Doing business as

Locations

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

{
    "created_epoch": "1436486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463616000000",
    "number": "1659755577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360920003",
            "telephone_number": "334-514-3848",
            "fax_number": "334-514-3686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2129 MOONBROOK DR",
            "city": "DADEVILLE",
            "state": "AL",
            "postal_code": "368535640",
            "telephone_number": "334-514-3848",
            "fax_number": "334-514-3686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY CREEK PREVENTION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-10",
        "last_updated": "2016-05-19",
        "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": "256-675-0412"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STILLWATERS FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ivy Creek of Tallapoosa LLC (Lake Martin Community Hospital)
• Ivy Creek of Tallapoosa LLC (Lake Martin Family Medicine)
• Ivy Creek of Tallapoosa, LLC (Stillwater's Family Care)
• Ivy Creek of Tallapoosa, LLC (Lake Martin Community Hospital)
• Ivy Creek of Tallapoosa, LLC (Reference Lab)
• Ivy Creek Specialty Care
• James W Ashcraft DMD LLC
• Jackie Jean Jennings, RPSGT
• Jims Pharmacy LLC (Jim's Pharmacy at the Lake)
• Anne-Marie Jones, SLP, ME, BS

• General Practice Physician in Dadeville, AL
• Providers in Dadeville, AL by specialty
• General Practice Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; 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.