Champion EMS

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

300228 Issued in TX

Legal business name

CHAMPION EMS

Doing business as

Christus EMS

Practice address

2201 S Mobberly Ave
Longview, TX 75602-3565

Phone

(903) 291-2600

Fax

(903) 291-2632

NPI assigned

Oct 2, 2006

Last updated

Jul 13, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shawn Salter

Title

Cao

Phone

(903) 291-2600

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• CHRISTUS EMS Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Mother Frances Hospital Regional Health Care Center

  dba Christus Specialty Pharmacy

  • Community/Retail Pharmacy
  • Tyler, TX
  • NPI 1417531021

  Member Of

  NPD member

Locations (25 of 26)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626134400000",
    "number": "1457444150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 S MOBBERLY AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756023565",
            "telephone_number": "903-291-2600",
            "fax_number": "903-291-2632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 S MOBBERLY AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756023565",
            "telephone_number": "903-291-2600",
            "fax_number": "903-291-2632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION EMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A",
        "authorized_official_last_name": "SALTER",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "903-291-2600"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "TX",
            "license": "300228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000712201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "AMB528",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHRISTUS EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew Daewon Cha
• Tejo Ramam Challa, MD
• Jimmy Alphonse Chamberlain
• Rachel Diana Chamberlain
• Jimmy Martin Chamness II, M.D.
• Jennifer S Chandler, M.D.
• Tammy Lynn Chandler, APRN
• Kelly Chang
• Betsy Jill Chappell, APRN
• Bryan James Chappuis, CRNA

• Land Ambulance in Longview, TX
• Providers in Longview, TX by specialty
• Land Ambulance in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.