Ivyy, P.C

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

540793 Issued in TX

Legal business name

IVYY, P.C

Practice address

2965 Harrison St Ste 313
Beaumont, TX 77702-1113

Phone

(409) 838-4472

NPI assigned

Oct 26, 2006

Organization subpart

No

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

Authorized official

Name

Vida Riston, CNM, FNP

Title

Ceo

Phone

(409) 838-4472

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621468800000",
    "number": "1487739439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2965 HARRISON ST STE 313",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021113",
            "telephone_number": "409-838-4472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2965 HARRISON ST STE 313",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021113",
            "telephone_number": "409-838-4472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVYY, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2021-05-20",
        "certification_date": "2021-01-12",
        "status": "A",
        "authorized_official_last_name": "RISTON",
        "authorized_official_first_name": "VIDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "409-838-4472",
        "authorized_official_credential": "CNM, FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "540793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; 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.