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General NPI Number Information
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NPI Number | 1538964119
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Entity Type | Organization
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Legal Business Name | IVY MOBILE MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 2580 W CAMP WISDOM RD STE 100
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-3089
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Country | US
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Telephone | 682-408-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 2580 W CAMP WISDOM RD STE 100 HQ-158
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052
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Country | US
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Telephone | 682-408-3552
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VANESSA WILLIAMS
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Credential |
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Telephone | 682-408-3552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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