Carrie    Carroll    NP
Contract Details
Ivy Creek Health
Facility name
Provider ID
P000000001
NPI
1639793334
Tax ID
320479195
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
6582 Boll Weevil Circle
Enterprise, AL 36330
United States
Phone
334-347-2027 (Phone)
Billing Details
Address
6582 Boll Weevil Circle
Enterprise, AL 36330
Billing Phone
334-347-2027
Specialty Type
Nurse Practitioner
Map
Address