Marlene    LaValley    NP
Contract Details
Ivy Creek Health
Facility name
Provider ID
P000000001
NPI
1043362734
Tax ID
631264086
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
4081 Alabama Highway 14
Millbrook, AL 36054
United States
Phone
334-285-3222 (Phone)
Billing Details
Address
4081 Alabama Highway 14
Millbrook, AL 36054
Billing Phone
334-285-3222
Specialty Type
Nurse Practitioner
Map
Address