Provider Demographics
NPI:1891730396
Name:METROPLEX CLINIC PHYSICIANS, INC.
Entity Type:Organization
Organization Name:METROPLEX CLINIC PHYSICIANS, INC.
Other - Org Name:ADVENTHEALTH MEDICAL GROUP CENTRAL TEXAS
Other - Org Type:Other Name
Authorized Official - Title/Position:CE-VP PHYSICIAN ENTERPRISE SW
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JASINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-568-4556
Mailing Address - Street 1:2201 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:254-519-8419
Mailing Address - Fax:254-519-8915
Practice Address - Street 1:2207 S CLEAR CREEK RD
Practice Address - Street 2:STE 204
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4132
Practice Address - Country:US
Practice Address - Phone:254-519-8419
Practice Address - Fax:254-519-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X, 207Q00000X, 207V00000X
TXM2221207RG0100X
TX207X00000X, 208800000X
TXN92302084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0033NEOtherBLUE CROSS BLUE SHIELD
TX178846501Medicaid
TX178846501Medicaid
TX0033NEOtherBLUE CROSS BLUE SHIELD