1629089966 NPI number — METROPLEX ADVENTIST HOSPITAL INC

Table of content: (NPI 1962549600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629089966 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:
Provider Other Organization Name Type Code:
6
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:
1629089966
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76115-0429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-519-8165
Provider Business Mailing Address Fax Number:
254-526-3483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 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:
76549-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-519-8165
Provider Business Practice Location Address Fax Number:
254-526-3483
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
254-519-8165

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  00397 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 00397 , 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: 0941197-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 094484501 . This is a "HASC - MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 450152 . This is a "WORKERS COMP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0941197-04 . This is a "MEDICAID-CSHCN ACUTE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0944845-03 . This is a "MEDCAID-CSHCN HASC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 176714400 . This is a "WORKERS COMP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 6541720 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 950570 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 450152 . This is a "STATE AGENCY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH0574 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 20489 . This is a "SCOTT & WHITE HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: METROPD . This is a "SCOTT & WHITE HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0941197-06 . This is a "CSHCN HASC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 104862100 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH0574 . This is a "ANTHEM LIFE INSURANCE COM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0941197-05 . This is a "HASC OP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 104862100 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 450152 . This is a "UNICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: H04501526 . This is a "STATE AGENCY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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