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General NPI Number Information
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NPI Number | 1417114380
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Entity Type | Organization
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Legal Business Name | ENNIS DIAGNOSTIC CENTER, INC.
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 104 S DALLAS ST
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City | ENNIS
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State | TX
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Zip | 75119-4745
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Country | US
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Telephone | 972-875-6961
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Fax | 972-875-8046
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Provider Business Mailing Address
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Address Line | PO BOX 86
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City | ENNIS
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State | TX
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Zip | 75120-0086
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Country | US
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Telephone | 972-875-6961
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM G YOUNG
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Credential |
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Telephone | 214-587-3760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0104673
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License Number State | TX
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