1750392916 NPI number — METROPLEX ADVENTIST HOSPITAL INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750392916 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:
1750392916
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 6397
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:
76115-0397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-551-2721
Provider Business Mailing Address Fax Number:
817-568-5545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 N KEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAMPASAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76550-1106
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:  007209 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 007209 , 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: 149073203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26641 . This is a "SCOTT & WHITE HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 451323 . This is a "UNICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 451323 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 149073202 . This is a "TEXAS MEDICAID HASC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 105789100 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 996901 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 105789100 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5856666 . This is a "AETNA" 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".




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