Bruce    Kent    MD
Contract Details
Ivy Creek Health
Facility name
Provider ID
P000000001
NPI
1336229608
Tax ID
631253446
Effective Date
7/7/2022
Last Updated
7/12/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
82.00
Location Details
Address
525 Hospital Drive
Wetumpka, AL 36093
United States
Phone
334-567-5626 (Phone)
Billing Details
Address
525 Hospital Drive
Wetumpka, AL 36093
Billing Phone
334-567-5626
Specialty Type
Family Practice
Website
Visit Website
Map
Address