Provider Demographics
NPI:1467591396
Name:CHRISTUS HEALTH ARK-LA-TEX
Entity Type:Organization
Organization Name:CHRISTUS HEALTH ARK-LA-TEX
Other - Org Name:CHRISTUS ST MICHAEL HEALTH CARE CENTER PHARMACY
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:702-738-4546
Mailing Address - Street 1:2604 SAINT MICHAEL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2378
Mailing Address - Country:US
Mailing Address - Phone:903-614-2200
Mailing Address - Fax:903-614-2868
Practice Address - Street 1:2604 SAINT MICHAEL DR STE 200
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2378
Practice Address - Country:US
Practice Address - Phone:903-614-2200
Practice Address - Fax:903-614-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35349183500000X
TX195093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145946407Medicaid
TX144972Medicaid