1346207255 NPI number — CHRISTOPHER L LUX

Table of content: CHRISTOPHER L LUX (NPI 1346207255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346207255 NPI number — CHRISTOPHER L LUX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUX
Provider First Name:
CHRISTOPHER
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1346207255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2602 SAINT MICHAEL DR
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-2387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-614-5111
Provider Business Mailing Address Fax Number:
903-614-5114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2602 SAINT MICHAEL DR
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503-2387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-614-5111
Provider Business Practice Location Address Fax Number:
903-614-5114
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  G5320 , 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: 5K575 . This is a "BCBS ARKANSAS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 200120690A . This is a "OKLAHOMA HEALTHCARE AUTHO" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: P00466535 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 112378001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 176094401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8X9803 . This is a "BCBS TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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