Tiffany    Hethcox    NP
Contract Details
Ivy Creek Health
Facility name
Provider ID
P000000001
NPI
1881282739
Tax ID
631253446
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
4412 Hogan Road
Deatsville, AL 36022
United States
Phone
334-543-4854 (Phone)
Billing Details
Address
4412 Hogan Road
Deatsville, AL 36022
Billing Phone
334-543-4854
Specialty Type
Nurse Practitioner
Map
Address