Contract Details
Ivy Creek of Tallapoosa, LLC
Facility name
Lake Martin Community Hospital
Provider ID
P000008036
NPI
1598783904
Tax ID
631282722
Effective Date
10/1/2014
Last Updated
10/17/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_231
Location Details
Address
201 Mariarden Road
Dadeville, AL 36853
United States
County
Tallapoosa
Phone
2568257821 (Phone)
Billing Details
Address
P.O. Box 629
Dadeville, AL 36853
Billing Phone
2568257821
Specialty Type
Hospital, Acute Care
Map
Address