1194787218 NPI number — CHRISTUS SANTA ROSA HEALTH CARE CORPORATION

Table of content: (NPI 1194787218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194787218 NPI number — CHRISTUS SANTA ROSA HEALTH CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTUS SANTA ROSA HEALTH CARE CORPORATION
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 SANTA ROSA 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:
1194787218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 846131
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-6131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-756-7999
Provider Business Mailing Address Fax Number:
469-282-1791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2827 BABCOCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-705-6190
Provider Business Practice Location Address Fax Number:
210-705-6094
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
210-704-3657

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 000339 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0003 . This is a "TRICARE FOR LIFE RD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7885153 . This is a "AETNA RN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 175884200 . This is a "US DEPT. OF LABOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 6548210 . This is a "AETNA RD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: H04980 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1013 . This is a "COMMUNITY FIRST RN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1013RN . This is a "COMMUNITY FIRST STAR RN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A7829101 . This is a "JOHN DEERE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0000 . This is a "TRICARE FOR LIFE RN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 094486001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 909665 . This is a "CONNECTICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1012 . This is a "COMMUNITY FIRST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 020844901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1012RD . This is a "COMMUNITY FIRST STAR RD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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