Healthcare Provider Details

I. General information

NPI: 1326113762
Provider Name (Legal Business Name): PALESTINE PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 S LOOP 256
PALESTINE TX
75801-8467
US

IV. Provider business mailing address

103 POWELL CT STE. 200
BRENTWOOD TN
37027-5079
US

V. Phone/Fax

Practice location:
  • Phone: 903-731-1000
  • Fax: 903-731-2236
Mailing address:
  • Phone: 615-372-8500
  • Fax: 615-372-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number000377
License Number StateTX

VIII. Authorized Official

Name: WILLIAM M. GRACEY
Title or Position: DOO
Credential:
Phone: 615-372-8500