Provider Demographics
NPI:1639171093
Name:METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES
Other - Org Name:METROPLEX MEDICAL 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:METROPLEX MEDICAL 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:817-543-4675
Practice Address - Street 1:906 W RANDOL MILL RD
Practice Address - Street 2:ARLINGTON CANCER CENTER
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2510
Practice Address - Country:US
Practice Address - Phone:817-261-4906
Practice Address - Fax:817-261-5837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-15
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
45D0659783OtherCLIA (CMS)
014329OtherCOLA
TX121904003Medicaid
014328OtherCOLA
45D0484531OtherCLIA (CMS)
TXCL0549Medicare ID - Type Unspecified