Provider Demographics
NPI:1568018661
Name:IVY CREEK FAMILY CARE OF TROY
Entity Type:Organization
Organization Name:IVY CREEK FAMILY CARE OF TROY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE & COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:H
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:334-514-3848
Mailing Address - Street 1:101 HUNTERS MOUNTAIN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081
Mailing Address - Country:US
Mailing Address - Phone:334-465-7056
Mailing Address - Fax:833-696-0057
Practice Address - Street 1:101 HUNTERS MOUNTAIN PARKWAY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081
Practice Address - Country:US
Practice Address - Phone:334-347-2027
Practice Address - Fax:334-347-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty