Provider Demographics
NPI:1457353815
Name:METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES
Other - Org Name:ARLINGTON CANCER CENTER AT TROPHY CLUB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:DISTEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-261-4906
Mailing Address - Street 1:PO BOX 974315
Mailing Address - Street 2:
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 1:2800 E STATE HIGHWAY 114
Practice Address - Street 2:ARLINGTON CANCER CENTER AT TROPHY CLUB
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5304
Practice Address - Country:US
Practice Address - Phone:817-261-4906
Practice Address - Fax:817-543-4675
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:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X
TX2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00502WMedicare ID - Type UnspecifiedCMS