Healthcare Provider Details

I. General information

NPI: 1134546096
Provider Name (Legal Business Name): SOUTH LIMESTONE HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 S VINE AVE
TYLER TX
75701-8539
US

IV. Provider business mailing address

701 MCCLINTIC DR
GROESBECK TX
76642-2128
US

V. Phone/Fax

Practice location:
  • Phone: 903-581-5714
  • Fax:
Mailing address:
  • Phone: 254-729-3281
  • Fax: 254-729-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number001025891
License Number StateTX

VIII. Authorized Official

Name: MR. LARRY PRICE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 254-729-3281