Provider Demographics
NPI:1578531422
Name:METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES
Other - Org Name:ARLINGTON CANCER CENTER AT TROPHY CLUB LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREL
Authorized Official - Middle Name:ADRIAAN
Authorized Official - Last Name:DICKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:817-261-4906
Mailing Address - Street 1:PO BOX 974315
Mailing Address - Street 2:ARLINGTON CANCER CENTER AT TROPHY CLUB LAB
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-4315
Mailing Address - Country:US
Mailing Address - Phone:817-261-4906
Mailing Address - Fax:817-261-5837
Practice Address - Street 1:2800 E STATE HWY 114
Practice Address - Street 2:SUITE 200 ARLINGTON CANCER CENTER AT TROPHY CLUB LAB
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5306
Practice Address - Country:US
Practice Address - Phone:817-837-3000
Practice Address - Fax:817-837-3005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
45D1044546OtherCLIA CMS
TXCL8598Medicare ID - Type Unspecified