Provider Demographics
NPI:1528378197
Name:IVY CREEK MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:IVY CREEK MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-514-3715
Mailing Address - Street 1:13 CAMBRIDGE COURT
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093
Mailing Address - Country:US
Mailing Address - Phone:334-514-3715
Mailing Address - Fax:334-514-6747
Practice Address - Street 1:201 MARIARDEN ROAD
Practice Address - Street 2:
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853
Practice Address - Country:US
Practice Address - Phone:256-825-0677
Practice Address - Fax:256-827-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies