MEDICARE: METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D1044546	OTHER		CLIA CMS

General Provider Information

NPI Number	:	1578531422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPLEX HEMATOLOGY ONCOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 974315
Second Line	:	ARLINGTON CANCER CENTER AT TROPHY CLUB LAB
City	:	DALLAS
State	:	TX
Zip	:	75397-4315
Country	:	US
Telephone Number	:	817-261-4906
Fax Number	:	817-261-5837

Provider Business Practice Location Address
First Line	:	2800 E STATE HWY 114
Second Line	:	SUITE 200 ARLINGTON CANCER CENTER AT TROPHY CLUB LAB
City	:	TROPHY CLUB
State	:	TX
Zip	:	76262-5306
Country	:	US
Telephone Number	:	817-837-3000
Fax Number	:	817-837-3005

Authorized Official
Title or Position	:	CEO MANAGING PARTNER
Name	:	KAREL ADRIAAN DICKE
Credential	:	MD PHD
Telephone Number	:	817-261-4906

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	05/08/2008

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