Organization
ENNIS DIAGNOSTIC CENTER, INC.
Active
Other names
Elite Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM G YOUNG (OWNER)
(214) 587-3760
Entity
Organization
Contact information
Practice address
104 S DALLAS ST, ENNIS, TX 75119-4745
(972) 875-6961
(972) 875-8046
Mailing address
PO BOX 86, ENNIS, TX 75120-0086
(972) 875-6961
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0104673
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2004095
—
TX
Enumeration date
05/19/2008
Last updated
03/02/2011
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