| Ennis Physical Medicine, Pllc | |
|
109 Nw Main St Ste B Ennis TX 75119-4079 | |
| (972) 293-9355 | |
| (915) 206-5076 |
| Full Name | Ennis Physical Medicine, Pllc |
|---|---|
| Speciality | General Practice |
| Location | 109 Nw Main St Ste B, Ennis, Texas |
| Authorized Official Name and Position | William Cameron Davis (CLINIC DIRECTOR) |
| Authorized Official Contact | 9722939355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ennis Physical Medicine, Pllc 109 Nw Main St Ste B Ennis TX 75119-4079 Ph: (972) 293-9355 | Ennis Physical Medicine, Pllc 109 Nw Main St Ste B Ennis TX 75119-4079 Ph: (972) 293-9355 |
| NPI Number | 1316439201 |
|---|---|
| Provider Enumeration Date | 06/05/2018 |
| Last Update Date | 06/05/2018 |
| Medicare PECOS PAC ID | 2668723263 |
|---|---|
| Medicare Enrollment ID | O20180920001863 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316439201 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | K5597 (Texas) | Primary |
| Provider Name | William C Davis |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1326045782 PECOS PAC ID: 0941298855 Enrollment ID: I20040430001175 |
| Provider Name | Hector Condarco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194242594 PECOS PAC ID: 3375818313 Enrollment ID: I20171002001785 |
| Provider Name | Deanna L. Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982369716 PECOS PAC ID: 1153716691 Enrollment ID: I20220318000685 |
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