Basic Information
| Provider Information | |||||||||
| NPI: | 1629089966 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METROPLEX ADVENTIST HOSPITAL INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVENTHEALTH CENTRAL TEXAS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6429 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761150429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545198165 | ||||||||
| FaxNumber: | 2545263483 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 S CLEAR CREEK RD | ||||||||
| Address2: | |||||||||
| City: | KILLEEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765494110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545198165 | ||||||||
| FaxNumber: | 2545263483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROBERTS | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2545198165 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 00397 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 282N00000X | 00397 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0941197-02 | 05 | TX | MEDICAID | 0944845-03 | 01 | TX | MEDCAID-CSHCN HASC | OTHER | 450152 | 01 | TX | WORKERS COMP | OTHER | 6541720 | 01 | TX | AETNA | OTHER | 104862100 | 01 | TX | FIRSTCARE | OTHER | 0941197-04 | 01 | TX | MEDICAID-CSHCN ACUTE | OTHER | 0941197-05 | 01 | TX | HASC OP | OTHER | 0941197-06 | 01 | TX | CSHCN HASC | OTHER | 104862100 | 01 | TX | FIRST HEALTH | OTHER | 176714400 | 01 | TX | WORKERS COMP | OTHER | METROPD | 01 | TX | SCOTT & WHITE HEALTH | OTHER | 094484501 | 01 | TX | HASC - MEDICAID | OTHER | 450152 | 01 | TX | STATE AGENCY | OTHER | HH0574 | 01 | TX | ANTHEM LIFE INSURANCE COM | OTHER | HH0574 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 20489 | 01 | TX | SCOTT & WHITE HEALTH | OTHER | 450152 | 01 | TX | UNICARE | OTHER | 950570 | 01 | TX | AETNA | OTHER | H04501526 | 01 | TX | STATE AGENCY | OTHER |