Lake Martin Family Medicine

LBN: Ivy Creek Of Tallapoosa Llc
Lake Martin Family Medicine is an health care organization with primary practice located at 301 Mariarden Rd , Dadeville AL 36853-0129. The organization recently has only one registered license in Ambulatory Health Care Facilities / Rural Health, which is considered as the primary health care specialty. Ivy Creek Of Tallapoosa Llc can be contacted via phone (256) 825-7871, or through Bruce, Michael D via phone (334) 567-4311.

Contact Information

Primary practice address
301 Mariarden Rd Dadeville AL 36853-0129
Phone: (256) 825-7871
Fax: (256) 825-5742
Website:
Map and Directions
Authorized official contact:
Name: Bruce, Michael D
Phone: (334) 567-4311

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Rural Health 261QR1300X

Profile Details

NPI number 1932130002
LBN Legal business name Ivy Creek Of Tallapoosa Llc
DBA Doing business as Lake Martin Family Medicine
Authorized official Bruce, Michael D
Entity Organization
Organization subpart 1 No
Enumeration date Jul 6th, 2006
Last updated Apr 5th, 2022 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932130002 NPPES
Alabama MEDICAID 540003420
Alabama Other 01D0920584

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