MEDICARE: CHRISTUS HEALTH SOUTHWESTERN LOUISIANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	273R00000X	Psychiatric Hospital Unit

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	60051	OTHER	LA	BLUE CROSS PSYCH
3	60836	OTHER	LA	BLUE CROSS CDU

General Provider Information

NPI Number	:	1861491375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTUS HEALTH SOUTHWESTERN LOUISIANA

Provider Business Mailing Address
First Line	:	PO BOX 846039
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6039
Country	:	US
Telephone Number	:	800-756-7999
Fax Number	:	469-282-1999

Provider Business Practice Location Address
First Line	:	524 DR MICHAEL DEBAKEY DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-5725
Country	:	US
Telephone Number	:	337-436-2511
Fax Number	:	469-282-1791

Authorized Official
Title or Position	:	CEO
Name	:	PAUL TREVINO
Credential	:
Telephone Number	:	409-899-8191

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/05/2022

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