Basic Information
| Provider Information | |||||||||
| NPI: | 1417950106 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRISTUS HEALTH NORTHERN LOUISIANA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CHRISTUS SHREVEPORT-BOSSIER HEALTH SYSTEM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 843577 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752843577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007567999 | ||||||||
| FaxNumber: | 4692821999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1453 E BERT KOUNS INDUSTRIAL LOOP | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711056800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186814500 | ||||||||
| FaxNumber: | 3186814177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TRAWICK | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | STEEN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3186815054 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0893235 | 01 | LA | CIGNA 20 SPRINT | OTHER | 340009 | 01 | LA | VALUE OPTION -MEDICAID HM | OTHER | 100699130A | 05 | OK | MEDICAID | 1744379 | 05 | LA | MEDICAID | HH7000 | 01 | TX | BCBSTX | OTHER | 108511105 | 05 | AR | MEDICAID | 0787749 | 01 | LA | AMERIGROUP | OTHER | 094645102 | 05 | TX | MEDICAID | 094645102 | 01 | LA | SUPERIOR HEALTH | OTHER | 1410667 | 05 | LA | MEDICAID | 90041 | 01 | LA | BLUE CROSS | OTHER | 01300144 | 05 | KY | MEDICAID | 015787302 | 05 | MO | MEDICAID | 0787749-01 | 05 | TX | MEDICAID | 127SCH170 | 01 | AL | BCBSAL | OTHER | 190041 | 01 | LA | STERLING OPTION 1 | OTHER |