Healthcare Provider Details

I. General information

NPI: 1164510673
Provider Name (Legal Business Name): PALESTINE PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 S LOOP 256
PALESTINE TX
75801-6958
US

IV. Provider business mailing address

680 S 4TH ST # KH3
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 903-731-1000
  • Fax: 903-731-2236
Mailing address:
  • Phone: 502-596-6063
  • Fax: 502-212-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JOHNETTA TRAYLOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 502-596-6063