Provider Demographics
NPI:1891816617
Name:METROPLEX MEDLINK PA
Entity Type:Organization
Organization Name:METROPLEX MEDLINK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:972-223-2760
Mailing Address - Street 1:PO BOX 7736
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-0736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 NORTH OLD HICKORY TRAIL
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-7809
Practice Address - Country:US
Practice Address - Phone:972-223-2760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE64972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCK7013OtherRR MEDICARE GROUP NUMBER
TXCK7013OtherRR MEDICARE GROUP NUMBER
TXC18945Medicare UPIN
TX8805N0Medicare ID - Type UnspecifiedINDIVIDUAL DALLAS COUNTY