Provider Demographics
NPI:1801822762
Name:CHRISTUS HEALTH NORTHERN LOUISIANA
Entity Type:Organization
Organization Name:CHRISTUS HEALTH NORTHERN LOUISIANA
Other - Org Name:CHRISTUS SHREVEPORT-BOSSIER HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:STEEN
Authorized Official - Last Name:TRAWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-681-5054
Mailing Address - Street 1:1453 E BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-6800
Mailing Address - Country:US
Mailing Address - Phone:318-681-4500
Mailing Address - Fax:318-681-4177
Practice Address - Street 1:1453 E BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-6800
Practice Address - Country:US
Practice Address - Phone:318-681-4500
Practice Address - Fax:318-681-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA193367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1945897Medicaid
LAH3938OtherBCBS
LA5CS97Medicare PIN