1003885641 NPI number — CHRISTUS SPOHN HEALTH SYSTEM CORPORATION

Table of content: (NPI 1003885641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003885641 NPI number — CHRISTUS SPOHN HEALTH SYSTEM CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTUS SPOHN HEALTH SYSTEM 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 SPOHN HOSPITAL ALICE
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:
1003885641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 847899
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:
75284-7899
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:
2500 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALICE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78332-4169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-664-4376
Provider Business Practice Location Address Fax Number:
361-668-2251
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLOW
Authorized Official First Name:
OSBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
361-288-2222

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: 006894 , 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: 094222901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0969 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1708712 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: B1613 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600933600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100701020B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200265360A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710617 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 094222902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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