Laura    Daniel    NP
Contract Details
Ivy Creek Health
Facility name
Provider ID
P000000001
NPI
1952634248
Tax ID
631282722
Effective Date
7/7/2022
Last Updated
7/15/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
82.00
Location Details
Address
301 Mariarden Road
Dadeville, AL 36853
United States
Phone
256-825-7871 (Phone)
Billing Details
Address
301 Mariarden Road
Dadeville, AL 36853
Billing Phone
256-825-5742
Specialty Type
Nurse Practitioner
Map
Address