MEDICARE: CITY OF ENNIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1437615390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF ENNIS

Provider Business Mailing Address
First Line	:	6600 9TH AVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-6411
Country	:	US
Telephone Number	:	409-962-5541
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 9TH AVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-6411
Country	:	US
Telephone Number	:	409-962-5541
Fax Number	:

Authorized Official
Title or Position	:	CITY MANAGER
Name	:	MARTY NELSON
Credential	:
Telephone Number	:	972-875-1234

Provider Enumeration Date	:	02/15/2019
Last Update Date	:	05/26/2021

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Directions to “CITY OF ENNIS ” Practice Location

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