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General NPI Number Information
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NPI Number | 1235979618
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Entity Type | Organization
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Legal Business Name | IVY INFUSION SERVICES, LLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 2222 INDIANA AVE
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City | LUBBOCK
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State | TX
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Zip | 79410-2100
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Country | US
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Telephone | 806-438-3544
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 INDIANA AVE
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City | LUBBOCK
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State | TX
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Zip | 79410-2100
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Country | US
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Telephone | 806-438-3544
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BROOKE HOBGOOD
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Credential | MD
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Telephone | 806-438-3544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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