Provider Demographics
NPI:1316970569
Name:METROPLEX ADVENTIST HOSPITAL, INC.
Entity type:Organization
Organization Name:METROPLEX ADVENTIST HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-519-8165
Mailing Address - Street 1:2115 S. CLEAR CREEK RD.
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549
Mailing Address - Country:US
Mailing Address - Phone:254-519-8930
Mailing Address - Fax:254-526-0075
Practice Address - Street 1:2115 S. CLEAR CREEK RD.
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549
Practice Address - Country:US
Practice Address - Phone:254-519-8930
Practice Address - Fax:254-526-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002578251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095172501Medicaid
TX677733OtherMCS LIFE INS
TX677733OtherSTERLING LIFE MCR
TX0005074210OtherAETNA
TX132428100OtherFIRST CARE
TX236103100OtherUS DEPT OF LABOR WC
TXHH8037OtherBLUE CROSS BLUE SHIELD
TX677733OtherHUMANA INS GOLD CHC MCR
TXN7148OtherHOMELINK
TXN7148OtherHOMELINK
TXN7148OtherHOMELINK