1821004151 NPI number — CHRISTUS SANTA ROSA HEALTH CARE CORPORATION

Table of content: (NPI 1821004151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821004151 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:
Provider Other Organization Name Type Code:
6
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:
1821004151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2022
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:
333 N SANTA ROSA ST
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:
78207-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-704-3907
Provider Business Practice Location Address Fax Number:
210-704-3758
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DASKEVICH
Authorized Official First Name:
CRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
210-704-4899

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X , with the licence number: 000339 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X , with the licence number: 000339 , registered in the state of TX ; 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: "N" .
  • Taxonomy code: 282NC2000X , 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: 909665 . This is a "CONNECTICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 38224 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1011RC . This is a "COMMUNITY FIRST STAR" 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: 0007 . This is a "TRICARE FOR LIFE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH0884 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1011 . This is a "COMMUNITY FIRST" 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: 094356502 . This is a "AMERICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 6542420 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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