Basic Information
| Provider Information | |||||||||
| NPI: | 1124482013 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRISTUS HEALTH SOUTHEAST TEXAS | ||||||||
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| OtherOrganizationName: | CHRISTUS SOUTHEAST TEXAS FAMILY PRACTICE AND WOMEN'S SERVICES CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848060 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752848060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007567999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 494 SPRINGHILL ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | JASPER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759514922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4093815750 | ||||||||
| FaxNumber: | 4093842018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2016 | ||||||||
| LastUpdateDate: | 04/07/2016 | ||||||||
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| AuthorizedOfficialLastName: | TREVINO | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4098997102 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.