CHRISTUS SOUTHEAST TEXAS - FAMILY PRACTICE CENTER SAM RAYBURN (CHRISTUS HEALTH SOUTHEAST TEXAS) NPI 1194797621

Clinic/Center (Rural Health) in Brookeland, TX

Organization Clinic/Center Rural Health

About CHRISTUS SOUTHEAST TEXAS - FAMILY PRACTICE CENTER SAM RAYBURN (CHRISTUS HEALTH SOUTHEAST TEXAS)

Christus Southeast Texas - Family Practice Center Sam Rayburn (christus Health Southeast Texas) is a provider established in Brookeland, Texas specializing in clinic/center. The NPI number of Christus Southeast Texas - Family Practice Center Sam Rayburn (christus Health Southeast Texas) is 1194797621 and was assigned on February 2006. The practitioner's primary taxonomy code is 261QR1300X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The provider's is doing business as Christus Southeast Texas - Family Practice Center Sam Rayburn.
The authorized official of this NPI record is Ms. Deborah R Wiegand Rn (Administrator)

NPI

1194797621

Provider NameCHRISTUS SOUTHEAST TEXAS - FAMILY PRACTICE CENTER SAM RAYBURN (CHRISTUS HEALTH SOUTHEAST TEXAS)
Provider Location Address2427 W RECREATIONAL ROAD 255 BROOKELAND, TX 75931
Provider Mailing AddressPO BOX 5316 SAM RAYBURN, TX 75951
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?Yes
Other Organization NameCHRISTUS SOUTHEAST TEXAS - FAMILY PRACTICE CENTER SAM RAYBURN
Other Name TypeDoing Business As (3)
Enumeration Date02-07-2006
Last Update Date07-23-2015

Primary Taxonomy

Taxonomy Code261QR1300X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationRural Health
License StateTX

Business Address

CHRISTUS SOUTHEAST TEXAS - FAMILY PRACTICE CENTER SAM RAYBURN (CHRISTUS HEALTH SOUTHEAST TEXAS)
2427 W RECREATIONAL ROAD 255
BROOKELAND, TX
ZIP 75931
Phone: (409) 698-9600
Fax: (409) 698-2800

Get Directions

Mailing Address

CHRISTUS SOUTHEAST TEXAS - FAMILY PRACTICE CENTER SAM RAYBURN (CHRISTUS HEALTH SOUTHEAST TEXAS)
PO BOX 5316
SAM RAYBURN, TX
ZIP 75951
Phone: (409) 384-1872
Fax: (409) 383-0622

Authorized Official

Authorized Official NameMS. DEBORAH R WIEGAND RN
Authorized Official TitleADMINISTRATOR
Authorized Official Phone(409) 384-1872

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
137305210MEDICAID (05)TX
458514MEDICARE OSCAR/CERTIFICATION (06)

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

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