Provider Demographics
NPI:1851823108
Name:IVY CREEK HEALTHCARE
Entity Type:Organization
Organization Name:IVY CREEK HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SAVANNAH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:205-585-3315
Mailing Address - Street 1:1210 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-3724
Mailing Address - Country:US
Mailing Address - Phone:205-280-0620
Mailing Address - Fax:
Practice Address - Street 1:1210 7TH ST S
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-3724
Practice Address - Country:US
Practice Address - Phone:205-280-0620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-140246261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care