Healthcare Provider Details

I. General information

NPI: 1538964119
Provider Name (Legal Business Name): IVY MOBILE MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 W CAMP WISDOM RD STE 100
GRAND PRAIRIE TX
75052-3089
US

IV. Provider business mailing address

2580 W CAMP WISDOM RD STE 100 HQ-158
GRAND PRAIRIE TX
75052
US

V. Phone/Fax

Practice location:
  • Phone: 682-408-3552
  • Fax:
Mailing address:
  • Phone: 682-408-3552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: VANESSA WILLIAMS
Title or Position: CEO
Credential:
Phone: 682-408-3552