Provider Demographics
NPI:1245401884
Name:TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-960-6539
Mailing Address - Street 1:500 E BORDER ST
Mailing Address - Street 2:MAILBOX 120
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-7445
Mailing Address - Country:US
Mailing Address - Phone:817-548-6130
Mailing Address - Fax:682-236-4620
Practice Address - Street 1:800 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:817-548-6130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOOCT68Medicare Oscar/Certification