| Name: | Ivy Creek Medical Equipment, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 22 Sep 2006 (18 years ago) |
| Entity Number: | 000-484-792 |
| Register Number: | 000484792 |
| County: | Autauga |
| Place of Formation: | Elmore County |
| Registered Office Street Address: | 466 EAST MAIN STREETPRATTVILLE, AL 36067 |
| Registered Office Street Address ZIP Code: | 36067 |
Activities
PROVIDE MEDICAL EQUIPMENT
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386069755 | 2014-02-21 | 2014-02-25 | 201 MARIARDEN RD, DADEVILLE, AL, 368536244, US | 13 CAMBRIDGE CT, WETUMPKA, AL, 360931261, US | |||||||||||||||||||||||||||||||
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| Phone | +1 334-514-3715 |
| Fax | 3345675423 |
Authorized person
| Name | MR. MICHAEL BRUCE |
| Role | OWNER |
| Phone | 2568250677 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 13290738 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009940367 |
| State | AL |
| Issuer | BCBS OF ALABAMA |
| Number | 51538455 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| WAITES, MICHAEL C | Agent | 466 EAST MAIN STREETPRATTVILLE, AL 36067 |
| Name | Role | Address |
|---|---|---|
| WAITES, MICHAEL C | Member | 466 EAST MAIN STREETPRATTVILLE, AL 36067 |
| Name | Role | Address |
|---|---|---|
| WAITES, MICHAEL C | Organizer | 466 EAST MAIN STREETPRATTVILLE, AL 36067 |
| IVY CREEK ASSOCIATESS LLC | Organizer | 203 SOUTH WASHINGTON STREETAUTAUGAVILLE, AL 36603 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
