MEDICARE: CHRISTUS HEALTH ARK-LA-TEX

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	183500000X	Pharmacist	35349	TX
2	3336C0003X	Community/Retail Pharmacy	19509	TX

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467591396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTUS HEALTH ARK-LA-TEX

Provider Business Mailing Address
First Line	:	2604 SAINT MICHAEL DR STE 200
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-2378
Country	:	US
Telephone Number	:	903-614-2200
Fax Number	:	903-614-2868

Provider Business Practice Location Address
First Line	:	2604 SAINT MICHAEL DR STE 200
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-2378
Country	:	US
Telephone Number	:	903-614-2200
Fax Number	:	903-614-2868

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASON MATTHEW ADAMS
Credential	:
Telephone Number	:	702-738-4546

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	05/12/2022

Similar Medicare Providers

1902865678 — HARRY KOURLIS JR. MD
Practice Location Address:

2604 SAINT MICHAEL DR STE 425
TEXARKANA, TX
75503-2378

Practice Phone: 903-614-5630
Practice Fax:

1346202579 — DR. WILLIAM JERRY ROBERTSON MD
Practice Location Address:

2604 ST MICHAEL DR , STE 410
TEXARKANA, TX
75503-2378

Practice Phone: 903-614-5430
Practice Fax: 903-614-5464

1578526901 — MRS. AMBER D BETHEA PA-C
Practice Location Address:

2604 SAINT MICHAEL DR STE 425
TEXARKANA, TX
75503-2378

Practice Phone: 903-614-5600
Practice Fax: 903-614-5630

1699739334 — DR. KARL F. WAGENHAUSER M.D.
Practice Location Address:

2602 SAINT MICHAEL DR STE 204
TEXARKANA, TX
75503-2378

Practice Phone: 903-614-5090
Practice Fax: 903-614-5150

1568404622 — BRENT WILLIAM ROBINSON M.D.
Practice Location Address:

2604 SAINT MICHAEL DR STE 345
TEXARKANA, TX
75503-2378

Practice Phone: 903-838-5500
Practice Fax: 903-838-7402

1497878474 — DR. KEVIN JOHN FORMES D.O.
Practice Location Address:

2604 SAINT MICHAEL DR STE 346
TEXARKANA, TX
75503-2378

Practice Phone: 903-614-5750
Practice Fax:

Directions to “CHRISTUS HEALTH ARK-LA-TEX ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.