MEDICARE: METRO TREATMENT OF TEXAS LP

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	251S00000X	Community/Behavioral Health Agency	SNP0305729	TX
2	3336C0002X	Clinic Pharmacy	TO145609	TX
3	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1831304625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO TREATMENT OF TEXAS LP

Provider Business Mailing Address
First Line	:	2500 MAITLAND CENTER PARKWAY
Second Line	:	SUITE 250
City	:	MAITLAND
State	:	FL
Zip	:	32751-4174
Country	:	US
Telephone Number	:	407-351-7080
Fax Number	:	407-351-6930

Provider Business Practice Location Address
First Line	:	1050 N WESTMORELAND RD STE 330
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-2458
Country	:	US
Telephone Number	:	214-946-5540
Fax Number	:	214-946-7450

Authorized Official
Title or Position	:	CFO
Name	:	MARIA JACKSON
Credential	:
Telephone Number	:	407-351-7080

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	11/04/2022

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