1073990289 NPI number — METROPLEX ADVENTIST HOSPITAL, INC

Table of content: (NPI 1073990289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073990289 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:
1073990289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2015
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:
76549-4110
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:
76549-4110
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:
04/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LISTER
Authorized Official First Name:
MAMIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR/DIRECTOR
Authorized Official Telephone Number:
254-519-8930

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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: 132428100 . This is a "FIRST CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 236103100 . This is a "US DOL/BLACK LUNG PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 677733 . This is a "HUMANA INSURANCE GOLD CHOICE MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: N7148 . This is a "HOMELINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 236103100 . This is a "US DEPARTMENT OF LABOR WC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005074210 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1316970569 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 677733 . This is a "STERLING LIFE MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 015 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 095172501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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