1184623266 NPI number — CHRISTUS HEALTH ARK-LA-TEX

Table of content: (NPI 1184623266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184623266 NPI number — CHRISTUS HEALTH ARK-LA-TEX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTUS HEALTH ARK-LA-TEX
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHRISTUS ST. MICHAEL HEALTH SYSTEM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184623266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75504-3070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-614-2943
Provider Business Mailing Address Fax Number:
903-614-2754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 SAINT MICHAEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-614-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
JASON
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-738-4546

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CJ5358 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0066DU . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 080804001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145960002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9R022 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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