MEDICARE: METROPLEX GERIATRIC ASSOCIATES PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
4	363A00000X	Physician Assistant
5	363L00000X	Nurse Practitioner
6	363LA2200X	Adult Health Nurse Practitioner
7	363LF0000X	Family Nurse Practitioner
8	207QG0300X	Geriatric Medicine (Family Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0034LM	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1841223435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPLEX GERIATRIC ASSOCIATES PA

Provider Business Mailing Address
First Line	:	9229 LYNDON B JOHNSON FWY
Second Line	:	SUITE 250
City	:	DALLAS
State	:	TX
Zip	:	75243-3405
Country	:	US
Telephone Number	:	972-739-3097
Fax Number	:	972-739-2673

Provider Business Practice Location Address
First Line	:	9229 LYNDON B JOHNSON FWY
Second Line	:	SUITE 250
City	:	DALLAS
State	:	TX
Zip	:	75243-3405
Country	:	US
Telephone Number	:	972-739-3097
Fax Number	:	972-739-2673

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLAY M. HEIGHTEN
Credential	:	M.D.
Telephone Number	:	972-739-3001

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	06/10/2008

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Directions to “METROPLEX GERIATRIC ASSOCIATES PA ” Practice Location

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