Provider Demographics
NPI:1295736734
Name:CHRISTUS HEALTH ARK-LA-TEX
Entity type:Organization
Organization Name:CHRISTUS HEALTH ARK-LA-TEX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-738-4546
Mailing Address - Street 1:PO BOX 848024
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8024
Mailing Address - Country:US
Mailing Address - Phone:800-756-7999
Mailing Address - Fax:469-282-1999
Practice Address - Street 1:2600 SAINT MICHAEL DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2372
Practice Address - Country:US
Practice Address - Phone:903-614-2019
Practice Address - Fax:903-614-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X, 282N00000X
TX000788282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146008105Medicaid
AR770010605OtherBREAST CARE
MO013954607Medicaid
TX56148Medicaid
LA1733229Medicaid
TX020976901Medicaid
TX094644402Medicaid
TXHH0902OtherBLUE CROSS
75503-0000OtherCHAMPUS
GA00410737XMedicaid
OK100703010CMedicaid
NJ8149704Medicaid
LA86487OtherBLUE CROSS
AR10063OtherBLUE CROSS
TX56148Medicaid
AR10063OtherBLUE CROSS