Basic Information
| Provider Information | |||||||||
| NPI: | 1679557888 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRISTUS HEALTH SOUTHEAST TEXAS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHRISTUS SOUTHEAST TEXAS - ST. ELIZABETH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848060 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752848060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007567999 | ||||||||
| FaxNumber: | 4692821999 | ||||||||
| Practice Location | |||||||||
| Address1: | 2830 CALDER ST | ||||||||
| Address2: | ADMINISTRATION | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777021809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098997171 | ||||||||
| FaxNumber: | 4098998191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TREVINO | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4098997102 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 282N00000X | 000444 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 138296205 | 05 | TX | MEDICAID | 450034 | 01 | TX | UNICARE | OTHER | 1732320 | 05 | LA | MEDICAID | 777020001 | 01 | TX | USFHP | OTHER | HH0542 | 01 | TX | BLUE CROSS | OTHER | 0910518 | 01 | TX | CIGNA | OTHER | 138296207 | 05 | TX | MEDICAID | 138296208 | 05 | TX | MEDICAID | 133240507 | 05 | TX | MEDICAID | 8060 | 01 | TX | UTMB CHIPS | OTHER | 777020001 | 01 | TX | CHAMPVA | OTHER | 0071717 | 01 | TX | AETNA | OTHER | 138296206 | 05 | TX | MEDICAID |