Provider Demographics
NPI:1063049625
Name:MISSION METROPLEX, INC.
Entity type:Organization
Organization Name:MISSION METROPLEX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-929-5080
Mailing Address - Street 1:210 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-7134
Mailing Address - Country:US
Mailing Address - Phone:817-277-6620
Mailing Address - Fax:817-277-3388
Practice Address - Street 1:212 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-7134
Practice Address - Country:US
Practice Address - Phone:817-277-9597
Practice Address - Fax:817-766-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty