Provider Demographics
NPI:1073559456
Name:IVY HEALTH CARE SUPPLY
Entity Type:Organization
Organization Name:IVY HEALTH CARE SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:ADIZA
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-499-1358
Mailing Address - Street 1:630 MURPHY ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477
Mailing Address - Country:US
Mailing Address - Phone:281-499-1358
Mailing Address - Fax:281-499-1682
Practice Address - Street 1:630 MURPHY ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-6888
Practice Address - Country:US
Practice Address - Phone:281-499-1358
Practice Address - Fax:281-499-1682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0067258332B00000X
TX5726820002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5726820002Medicare NSC