Provider Demographics
NPI:1881646941
Name:ENNIS HEALTHCARE SYSTEMS INC
Entity Type:Organization
Organization Name:ENNIS HEALTHCARE SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-943-9431
Mailing Address - Street 1:PO BOX 3770
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1070
Mailing Address - Country:US
Mailing Address - Phone:972-875-7488
Mailing Address - Fax:972-875-7508
Practice Address - Street 1:2200 PHYSICANS BLVD STE D
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-6248
Practice Address - Country:US
Practice Address - Phone:972-875-7488
Practice Address - Fax:972-875-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0065LTOtherBCBS
TX00446XMedicare ID - Type Unspecified