Provider Demographics
NPI:1598749707
Name:CHRISTUS HEALTH SOUTHEAST TEXAS
Entity Type:Organization
Organization Name:CHRISTUS HEALTH SOUTHEAST TEXAS
Other - Org Name:CHRISTUS SOUTHEAST TEXAS - JASPER MEMORIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-899-7102
Mailing Address - Street 1:PO BOX 848060
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8060
Mailing Address - Country:US
Mailing Address - Phone:800-756-7999
Mailing Address - Fax:469-282-1999
Practice Address - Street 1:1275 MARVIN HANCOCK DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4935
Practice Address - Country:US
Practice Address - Phone:409-384-5461
Practice Address - Fax:409-384-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
TX000038282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75270390475951OtherCHAMPVA
TXHH0633OtherBLUE CROSS
TX112706001Medicaid
TX450573OtherUNICARE
TX8059OtherUTMB CHIPS
TX0921543OtherCIGNA
TX112706002Medicaid
TX112706003Medicaid
TX759510003OtherUSFHP
TX0873414OtherAETNA
TX112706002Medicaid
TX0921543OtherCIGNA
TX8059OtherUTMB CHIPS