CHRISTUS HEALTH SOUTHEAST TEXAS

Provider Demographics

• NPI: 1679557888
• Name: CHRISTUS HEALTH SOUTHEAST TEXAS
• Entity Type: Organization
• Organization Name: CHRISTUS HEALTH SOUTHEAST TEXAS
• Other - Org Name: CHRISTUS SOUTHEAST TEXAS - ST. ELIZABETH
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: PAUL
• Authorized Official - Last Name: TREVINO
• Authorized Official - Phone: 409-899-7102
• Mailing Address - Street 1: PO BOX 848060
• 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: 2830 CALDER ST
• Practice Address - Street 2: ADMINISTRATION
• Practice Address - City: BEAUMONT
• Practice Address - State: TX
• Practice Address - Zip Code: 77702-1809
• Practice Address - Country: US
• Practice Address - Phone: 409-899-7171
• Practice Address - Fax: 409-899-8191
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-12-01
• Last Update Date: 2022-10-19

Provider Licenses

State	License ID	Taxonomies
		261QA1903X, 363A00000X, 363L00000X, 367500000X
TX	000444	282N00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	282N00000X	Hospitals	General Acute Care Hospital		Group - Multi-Specialty
No	261QA1903X	Ambulatory Health Care Facilities	Clinic/Center	Ambulatory Surgical	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	367500000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Anesthetist, Certified Registered		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TX	138296205	Medicaid
TX	450034	Other	UNICARE
LA	1732320	Medicaid
TX	777020001	Other	USFHP
TX	HH0542	Other	BLUE CROSS
TX	0910518	Other	CIGNA
TX	138296207	Medicaid
TX	138296208	Medicaid
TX	133240507	Medicaid
TX	8060	Other	UTMB CHIPS
TX	777020001	Other	CHAMPVA
TX	0071717	Other	AETNA
TX	138296206	Medicaid
TX	138296208	Medicaid
TX	138296207	Medicaid
TX	138296208	Medicaid