Organization
METROPLEX ADVENTIST HOSPITAL CRNA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY L JOHNSON (VICE PRESIDENT/CFO)
(254) 519-8165
Entity
Organization
Contact information
Practice address
2201 S CLEAR CREEK RD, KILLEEN, TX 76549-4110
(254) 519-8165
Mailing address
PO BOX 938, KILLEEN, TX 76540-0938
(254) 634-6999
(254) 200-4099
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C91V
BCBS OF TEXAS
TX
05
—
193418401
—
TX
Enumeration date
10/19/2007
Last updated
10/06/2008
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