MEDICARE: ENNIS HEALTHCARE SYSTEMS INC

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	101YP2500X	Professional Counselor
2	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0065LT	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1881646941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENNIS HEALTHCARE SYSTEMS INC

Provider Business Mailing Address
First Line	:	PO BOX 3770
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1070
Country	:	US
Telephone Number	:	972-875-7488
Fax Number	:	972-875-7508

Provider Business Practice Location Address
First Line	:	2200 PHYSICANS BLVD STE D
Second Line	:
City	:	ENNIS
State	:	TX
Zip	:	75119-6248
Country	:	US
Telephone Number	:	972-875-7488
Fax Number	:	972-875-7508

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LINDA L RILEY
Credential	:
Telephone Number	:	214-943-9431

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/07/2011

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Directions to “ENNIS HEALTHCARE SYSTEMS INC ” Practice Location

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