Basic Information
| Provider Information | |||||||||
| NPI: | 1750392916 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METROPLEX ADVENTIST HOSPITAL INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVENTHEALTH ROLLINS BROOK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6397 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761150397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175512721 | ||||||||
| FaxNumber: | 8175685545 | ||||||||
| Practice Location | |||||||||
| Address1: | 608 N KEY AVE | ||||||||
| Address2: | |||||||||
| City: | LAMPASAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765501106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545198165 | ||||||||
| FaxNumber: | 2545263483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 01/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | ROBERTS | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2545198165 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 007209 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 282NC0060X | 007209 | TX | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 451323 | 01 | TX | UNICARE | OTHER | 26641 | 01 | TX | SCOTT & WHITE HEALTH | OTHER | HH0574 | 01 | TX | ANTHEM LIFE INSURANCE COM | OTHER | 149073202 | 01 | TX | TEXAS MEDICAID HASC | OTHER | 5856666 | 01 | TX | AETNA | OTHER | 451323 | 01 | TX | WORKERS COMPENSATION | OTHER | 996901 | 01 | TX | AETNA | OTHER | 105789100 | 01 | TX | FIRST HEALTH | OTHER | 149073203 | 05 | TX | MEDICAID | 105789100 | 01 | TX | FIRSTCARE | OTHER |