Ivy Creek Family Care

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

IVY CREEK FAMILY CARE

Practice address

201 S Washington St
Autaugaville, AL 36003-2535

Phone

(334) 361-7316

Fax

(334) 361-7858

NPI assigned

Aug 10, 2012

Last updated

Sep 28, 2012By 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

James Gordon Faulk

Title

Ceo

Phone

(334) 361-7316

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1344556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348790400000",
    "number": "1972850741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "AUTAUGAVILLE",
            "state": "AL",
            "postal_code": "360030490",
            "telephone_number": "334-361-7316",
            "fax_number": "334-361-7858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S WASHINGTON ST",
            "city": "AUTAUGAVILLE",
            "state": "AL",
            "postal_code": "360032535",
            "telephone_number": "334-361-7316",
            "fax_number": "334-361-7858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY CREEK FAMILY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-10",
        "last_updated": "2012-09-28",
        "status": "A",
        "authorized_official_last_name": "FAULK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "GORDON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-361-7316"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Autauga Medical Clinic LLC
• Lee Carter, M.D.
• Health Services Inc (Autaugaville Family Health Center)
• Judy Johnson, RPH.
• Bruce McAlpin Jones, MD
• Diana L Kenyon, CRNP
• Whitaker Drugs Autaugaville, LLC

• Clinic/Center in Autaugaville, AL
• Providers in Autaugaville, AL by specialty
• Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; 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.