1679557888 NPI number — CHRISTUS HEALTH SOUTHEAST TEXAS

Table of content: (NPI 1679557888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679557888 NPI number — CHRISTUS HEALTH SOUTHEAST TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTUS HEALTH SOUTHEAST TEXAS
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 SOUTHEAST TEXAS - ST. ELIZABETH
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:
1679557888
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848060
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:
75284-8060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-756-7999
Provider Business Mailing Address Fax Number:
469-282-1999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2830 CALDER ST
Provider Second Line Business Practice Location Address:
ADMINISTRATION
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77702-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-899-7171
Provider Business Practice Location Address Fax Number:
409-899-8191
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TREVINO
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
409-899-7102

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: 000444 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 138296205 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 450034 . This is a "UNICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1732320 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 777020001 . This is a "USFHP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH0542 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0910518 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 138296207 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138296208 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133240507 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8060 . This is a "UTMB CHIPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 777020001 . This is a "CHAMPVA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0071717 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 138296206 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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