Ivy Health Care Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

5726820002 Issued in TX

Legal business name

IVY HEALTH CARE SUPPLY

Practice address

630 Murphy Road
Suite 109
Stafford, TX 77477-6888

Phone

(281) 499-1358

Fax

(281) 499-1682

NPI assigned

Jun 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vivian Adiza Yusuf

Title

Owner

Phone

(281) 499-1358

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215734400000",
    "number": "1073559456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 MURPHY ROAD",
            "address_2": "SUITE 109",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "77477",
            "telephone_number": "281-499-1358",
            "fax_number": "281-499-1682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 MURPHY ROAD",
            "address_2": "SUITE 109",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774776888",
            "telephone_number": "281-499-1358",
            "fax_number": "281-499-1682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY HEALTH CARE SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2008-07-11",
        "status": "A",
        "authorized_official_last_name": "YUSUF",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_middle_name": "ADIZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "281-499-1358"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "0067258",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "5726820002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gina Marie Jackson
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• Durable Medical Equipment & Medical Supplies in Stafford, TX
• Providers in Stafford, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.