1164423414 NPI number — METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES

Table of content: (NPI 1164423414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164423414 NPI number — METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES
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:
1164423414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 974315
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75397-4315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-261-4906
Provider Business Mailing Address Fax Number:
817-543-4675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
906 W RANDOL MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76012-2510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-261-4906
Provider Business Practice Location Address Fax Number:
817-543-4675
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DISTEFANO
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
817-261-4906

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  16659 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 16659 , 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)





Copyright © 2007-2025 www.npivalidator.com