NPIMap

Organization Active NPI

Palestine Principal Healthcare Limited Partnership

Doing business as Palestine Regional Medical Center EMS

  • Ambulance
  • Palestine, TX
National Provider Identifier
1093964264
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
License
300202 Issued in TX
Legal business name
PALESTINE PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP
Doing business as
Palestine Regional Medical Center EMS
Practice address
4000 S Loop 256
Palestine, TX 75801-8467
Phone
(903) 731-5398
Fax
(903) 731-4219
NPI assigned
Sep 12, 2008
Last updated
Jun 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2025

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

Authorized official

Name
Johnetta Traylor
Title
Administrator
Phone
(502) 596-6063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X 300202 TX Primary

Addresses

Primary practice location

4000 S Loop 256
Palestine, TX 75801-8467

Mailing address

680 S 4TH St # KH3
Louisville, KY 40202-2407
Phone (502) 596-6063

Other names 1

  • Palestine Regional Medical Center EMS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090120000031 TX Part B Supplier - Ambulance Service Supplier 7214844976 Practice locations: Palestine, TX

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1030133Palestine Regional Medical Center EMS4000 South Loop 256, Palestine, TX 75801Certificate of waiverAug 30, 2026

National Provider Directory

National Provider Directory
Tax ID family
Palestine Principal5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4000 S Loop 256
#M
Palestine, TX 75801
Phone (903) 731-5000

NPI Registry JSON

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

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1093964264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 S 4TH ST # KH3",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022407",
            "telephone_number": "502-596-6063",
            "fax_number": "502-212-8481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 S LOOP 256",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758018467",
            "telephone_number": "903-731-5398",
            "fax_number": "903-731-4219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALESTINE PRINCIPAL HEALTHCARE LIMITED PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-12",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A",
        "authorized_official_last_name": "TRAYLOR",
        "authorized_official_first_name": "JOHNETTA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "502-596-6063"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "TX",
            "license": "300202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palestine Regional Medical Center EMS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Palestine Regional Medical Center EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palestine, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; 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.