Provider Demographics
NPI:1598896664
Name:JUAN J. PINEDA, P.C.
Entity Type:Organization
Organization Name:JUAN J. PINEDA, P.C.
Other - Org Name:JUAN J. PINEDA, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAYNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-445-9764
Mailing Address - Street 1:3300 VAWTER SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-8609
Mailing Address - Country:US
Mailing Address - Phone:573-445-9764
Mailing Address - Fax:
Practice Address - Street 1:3300 VAWTER SCHOOL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-8609
Practice Address - Country:US
Practice Address - Phone:573-445-9764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3P42207R00000X
207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206996613Medicaid
MODG1835OtherRAILROAD MEDICARE
MODG1835OtherRAILROAD MEDICARE
6520OtherBLUE CROSS
6520OtherBLUE CROSS