Healthcare Provider Details

I. General information

NPI: 1174892152
Provider Name (Legal Business Name): METROPLEX ADVENTIST HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S CLEAR CREEK RD
KILLEEN TX
76549-4110
US

IV. Provider business mailing address

PO BOX 6429
FORT WORTH TX
76115-0429
US

V. Phone/Fax

Practice location:
  • Phone: 254-519-8155
  • Fax:
Mailing address:
  • Phone: 817-551-2721
  • Fax: 817-568-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number000397
License Number StateTX

VIII. Authorized Official

Name: MR. VICTOR LAWHORN
Title or Position: VICE PRESIDENT/ CFO
Credential:
Phone: 254-519-8165