Basic Information
| Provider Information | |||||||||
| NPI: | 1093783391 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRISTUS SPOHN HEALTH SYSTEM CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHRISTUS SPOHN HOSPITAL KLEBERG | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 847899 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752847899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007567999 | ||||||||
| FaxNumber: | 4692821999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 GENERAL CAVAZOS BLVD | ||||||||
| Address2: | |||||||||
| City: | KINGSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783637197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615951661 | ||||||||
| FaxNumber: | 3615955005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | BLOW | ||||||||
| AuthorizedOfficialFirstName: | OSBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3612882222 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 282N00000X | 000216 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 136436604 | 05 | TX | MEDICAID | HH0359 | 01 | TX | BLUE CROSS | OTHER | XHSP42260 | 05 | CA | MEDICAID | 000A4183 | 05 | NM | MEDICAID | 136436606 | 05 | TX | MEDICAID | 1763896 | 05 | LA | MEDICAID | 450163 | 01 | TX | UNITED HEALTH | OTHER | XHSP32260 | 05 | CA | MEDICAID | 0955302 | 05 | IA | MEDICAID | 3015039 | 05 | WA | MEDICAID |