Provider Demographics
NPI:1073983920
Name:PINEWOOD MEDICAL LLC
Entity Type:Organization
Organization Name:PINEWOOD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORSBON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:615-512-4099
Mailing Address - Street 1:10256 MCGEE RD
Mailing Address - Street 2:
Mailing Address - City:LYLES
Mailing Address - State:TN
Mailing Address - Zip Code:37098-1738
Mailing Address - Country:US
Mailing Address - Phone:615-512-4099
Mailing Address - Fax:
Practice Address - Street 1:3499 HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-4234
Practice Address - Country:US
Practice Address - Phone:615-512-4099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty