Ivy Creek Medical Equipment, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

1307 Issued in AL

Legal business name

IVY CREEK MEDICAL EQUIPMENT, LLC

Doing business as

Ivy Creek Medical Equipment

Practice address

201 Mariarden Rd
Dadeville, AL 36853-6244

Phone

(256) 825-0677

Fax

(256) 827-0803

NPI assigned

Sep 20, 2006

Last updated

Feb 18, 2014By 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 Bruce

Title

Owner/Director

Phone

(256) 825-0677

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Ivy Creek Medical Equipment Doing business as

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392681600000",
    "number": "1962509182",
    "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": "256-825-0677",
            "fax_number": "256-827-0803"
        },
        {
            "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": "256-825-0677",
            "fax_number": "256-827-0803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY CREEK MEDICAL EQUIPMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2014-02-18",
        "status": "A",
        "authorized_official_last_name": "BRUCE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "256-825-0677",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AL",
            "license": "715",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AL",
            "license": "1307",
            "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": [
        {
            "organization_name": "Ivy Creek Medical Equipment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Dadeville, AL
• Providers in Dadeville, 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 18, 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.