Provider Demographics
NPI:1073990289
Name:METROPLEX ADVENTIST HOSPITAL, INC
Entity Type:Organization
Organization Name:METROPLEX ADVENTIST HOSPITAL, INC
Other - Org Name:HOME CARE OF METROPLEX HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LISTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:254-519-8930
Mailing Address - Street 1:2115 S CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4110
Mailing Address - Country:US
Mailing Address - Phone:254-519-8930
Mailing Address - Fax:254-526-0075
Practice Address - Street 1:2115 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-519-8930
Practice Address - Fax:254-526-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
132428100OtherFIRST CARE
236103100OtherUS DOL/BLACK LUNG PROVIDER
677733OtherHUMANA INSURANCE GOLD CHOICE MEDICARE
N7148OtherHOMELINK
236103100OtherUS DEPARTMENT OF LABOR WC
0005074210OtherAETNA
1316970569OtherNPI
677733OtherSTERLING LIFE MEDICARE
015OtherTRICARE
TX095172501Medicaid
TX677733Medicare Oscar/Certification
236103100OtherUS DEPARTMENT OF LABOR WC