Ivy Diagnostics LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

IVY DIAGNOSTICS LLC

Practice address

915 W Exchange Pkwy Ste 280
Allen, TX 75013-7031

Phone

(972) 922-5321

NPI assigned

Feb 9, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Alicia Ronnette Gray, DMDNPI 1336299718

Title

Director

Phone

(972) 922-5321

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alicia R Gray, DDS,DMD

  • Endodontics
  • Allen, TX
  • NPI 1336299718
  NPD Authorized official

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

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1821742701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 W EXCHANGE PKWY STE 280",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750137031",
            "telephone_number": "972-922-5321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 W EXCHANGE PKWY STE 280",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750137031",
            "telephone_number": "972-922-5321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-09",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-08",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "RONNETTE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "972-922-5321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Allen, TX
• Providers in Allen, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; 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.