Provider Demographics
NPI:1811421886
Name:IVY CREEK OF ELMORE LLC
Entity Type:Organization
Organization Name:IVY CREEK OF ELMORE LLC
Other - Org Name:ARMSTRONG GENERAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RITZUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-567-4311
Mailing Address - Street 1:515 HOSPITAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-1626
Mailing Address - Country:US
Mailing Address - Phone:334-514-3688
Mailing Address - Fax:334-567-4312
Practice Address - Street 1:515 HOSPITAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-1626
Practice Address - Country:US
Practice Address - Phone:334-514-3688
Practice Address - Fax:334-567-4312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010097Medicare PIN