Provider Demographics
NPI:1467453902
Name:CHRISTUS HEALTH ARK-LA-TEX
Entity Type:Organization
Organization Name:CHRISTUS HEALTH ARK-LA-TEX
Other - Org Name:CHRISTUS ST MICHAEL REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
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:903-614-2001
Mailing Address - Street 1:2400 SAINT MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2374
Mailing Address - Country:US
Mailing Address - Phone:903-614-4000
Mailing Address - Fax:903-614-8463
Practice Address - Street 1:2400 SAINT MICHAEL DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2374
Practice Address - Country:US
Practice Address - Phone:903-614-4000
Practice Address - Fax:903-614-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273Y00000X
TX000713283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094353202Medicaid
75504-0000OtherCHAMPUS
TXHH0896OtherBLUE CROSS
OK100703010AMedicaid
AR10522OtherBLUE CROSS
AR146092126Medicaid
LA34337OtherBLUE CROSS