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General NPI Number Information
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NPI Number | 1164572830
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Entity Type | Organization
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Legal Business Name | PALESTINE PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 2900 SOUTH LOOP 256
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City | PALESTINE
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State | TX
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Zip | 75801
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Country | US
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Telephone | 903-731-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 680 S 4TH ST # KH3
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City | LOUISVILLE
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State | KY
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Zip | 40202-2407
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Country | US
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Telephone | 502-596-6063
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Fax | 502-212-8481
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHNETTA TRAYLOR
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Credential |
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Telephone | 502-596-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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