| Name: | Ivy Creek Medical Associates LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 17 May 2023 (a year ago) |
| Entity Number: | 001-079-845 |
| Register Number: | 001079845 |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 500 Hospital DriveWetumpka, AL 36092-1625 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659055184 | 2023-06-14 | 2023-06-14 | PO BOX 130, WETUMPKA, AL, 360920003, US | 73996 TALLASSEE HWY, WETUMPKA, AL, 360927310, US | |||||||||||||
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| Phone | +1 334-567-4311 |
Authorized person
| Name | MICHAEL D BRUCE |
| Role | CEO |
| Phone | 2566750412 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Bruce, Tanya | Organizer | 500 Hospital DriveWetumpka, AL 36092 |
| Name | Role | Address |
|---|---|---|
| IVY CREEK HEALTHCARE, LLC | Agent | 16020 SW 80TH AVENUEMIAMI, FL 33157 |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
