Organization
GENERAL AND VASCULAR SURGERY OF ENNIS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M SULLIVAN MD (OWNER)
(972) 878-4700
Entity
Organization
Contact information
Practice address
802 W LAMPASAS ST, ENNIS, TX 75119-4500
(972) 878-4700
(972) 878-2238
Mailing address
802 W LAMPASAS ST, ENNIS, TX 75119-4500
(972) 878-4700
(972) 878-2238
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00266V
MEDICARE PTAN
TX
05
—
159614002
—
TX
Enumeration date
11/03/2005
Last updated
06/14/2024
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