1467453902 NPI number — CHRISTUS HEALTH ARK-LA-TEX

Table of content: (NPI 1467453902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467453902 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 REHABILITATION HOSPITAL
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:
1467453902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 SAINT MICHAEL DR
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:
75503-2374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-614-4000
Provider Business Mailing Address Fax Number:
903-614-8463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 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:
75503-2374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-614-4000
Provider Business Practice Location Address Fax Number:
903-614-8463
Provider Enumeration Date:
08/09/2005

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:
903-614-2001

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 283X00000X , with the licence number: 000713 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 094353202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75504-0000 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH0896 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100703010A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10522 . This is a "BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 146092126 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34337 . This is a "BLUE CROSS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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