1316970569 NPI number — METROPLEX ADVENTIST HOSPITAL, INC.

Table of content: (NPI 1316970569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316970569 NPI number — METROPLEX ADVENTIST HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPLEX ADVENTIST HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOME CARE OF METROPLEX HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316970569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2115 S. CLEAR CREEK RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILLEEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-519-8930
Provider Business Mailing Address Fax Number:
254-526-0075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2115 S. CLEAR CREEK RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILLEEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-519-8930
Provider Business Practice Location Address Fax Number:
254-526-0075
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROCK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
254-519-8165

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  002578 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 095172501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 677733 . This is a "MCS LIFE INS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 677733 . This is a "STERLING LIFE MCR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0005074210 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 132428100 . This is a "FIRST CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 236103100 . This is a "US DEPT OF LABOR WC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH8037 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 677733 . This is a "HUMANA INS GOLD CHC MCR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: N7148 . This is a "HOMELINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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