Provider Demographics
NPI:1790162238
Name:CHRISTUS HEALTH ARK-LA-TEX
Entity Type:Organization
Organization Name:CHRISTUS HEALTH ARK-LA-TEX
Other - Org Name:CHRISTUS ST MICHAEL ONCOLOGY CLINIC
Other - Org Type:Other Name
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:PO BOX 3070
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75504-3070
Mailing Address - Country:US
Mailing Address - Phone:903-614-2943
Mailing Address - Fax:903-614-2754
Practice Address - Street 1:2602 SAINT MICHAEL DR STE 202
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5221
Practice Address - Country:US
Practice Address - Phone:903-614-5480
Practice Address - Fax:903-614-5483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00572NMedicare PIN