Provider Demographics
NPI:1669863601
Name:TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-960-6539
Mailing Address - Street 1:PO BOX 910818
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-0818
Mailing Address - Country:US
Mailing Address - Phone:817-960-6130
Mailing Address - Fax:682-236-4620
Practice Address - Street 1:800 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:817-548-6100
Practice Address - Fax:817-548-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000422261QR0404X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare UPIN