Provider Demographics
NPI:1760624639
Name:RAYMUND O. PINEDA, M.D., LLC
Entity Type:Organization
Organization Name:RAYMUND O. PINEDA, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMUND
Authorized Official - Middle Name:O
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-829-3400
Mailing Address - Street 1:4400 S LIMIT AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-1179
Mailing Address - Country:US
Mailing Address - Phone:660-829-3400
Mailing Address - Fax:660-829-3433
Practice Address - Street 1:4400 S LIMIT AVE
Practice Address - Street 2:STE B
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-1179
Practice Address - Country:US
Practice Address - Phone:660-829-3400
Practice Address - Fax:660-829-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005004444207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO38568029OtherBC BS
1841262789OtherNPI GROUP
1760624639OtherNPI INDIVIDUAL
MA1749001OtherMEDICARE GROUP
MOMA1749Medicare UPIN