Healthcare Provider Details

I. General information

NPI: 1861608382
Provider Name (Legal Business Name): METRO TREATMENT OF TEXAS LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 W COMMERCE ST
SAN ANTONIO TX
78207-3611
US

IV. Provider business mailing address

2500 MAITLAND CENTER PARKWAY SUITE 250
MAITLAND FL
32751-4174
US

V. Phone/Fax

Practice location:
  • Phone: 210-314-6473
  • Fax: 210-314-8676
Mailing address:
  • Phone: 407-351-7080
  • Fax: 407-351-6930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSNP0801511
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberMO128273
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MARIA JACKSON
Title or Position: CFO
Credential:
Phone: 407-351-7080