Provider Demographics
NPI:1609896158
Name:PINEWOOD MEDICAL CLINIC, PA
Entity Type:Organization
Organization Name:PINEWOOD MEDICAL CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-321-3110
Mailing Address - Street 1:6318 FM 1488 RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2522
Mailing Address - Country:US
Mailing Address - Phone:936-321-3110
Mailing Address - Fax:936-321-3125
Practice Address - Street 1:6318 FM 1488 RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2522
Practice Address - Country:US
Practice Address - Phone:936-321-3110
Practice Address - Fax:936-321-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI11199Medicare UPIN
TX00100XMedicare ID - Type Unspecified