Provider Demographics
NPI:1457359879
Name:ROY IVY JR ASSOCIATES
Entity Type:Organization
Organization Name:ROY IVY JR ASSOCIATES
Other - Org Name:OB GYN ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:IVY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:915-532-4631
Mailing Address - Street 1:1700 CURIE DR
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2905
Mailing Address - Country:US
Mailing Address - Phone:915-532-4631
Mailing Address - Fax:915-544-9461
Practice Address - Street 1:1700 CURIE DR
Practice Address - Street 2:SUITE 2000
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2905
Practice Address - Country:US
Practice Address - Phone:915-532-4631
Practice Address - Fax:915-544-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5045207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084257701Medicaid
00N648Medicare ID - Type Unspecified