Organization
PRHC - ENNIS LP
Active
Other names
Ennis Regional Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR (AUTHORIZED OFFICAL)
(502) 596-6063
Entity
Organization
Contact information
Practice address
2201 WEST LAMPASAS ST, ENNIS, TX 75119-5644
(972) 875-0900
Mailing address
680 S 4TH ST # KH-3, LOUISVILLE, KY 40202-2407
(502) 596-6044
(502) 212-8481
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207VX0000X
Obstetrics Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121822401
—
TX
05
—
121822403
—
TX
Enumeration date
01/12/2007
Last updated
06/11/2025
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