Provider Demographics
NPI:1952623209
Name:PINEYWOODS HEALTHCARE PLLC
Entity Type:Organization
Organization Name:PINEYWOODS HEALTHCARE PLLC
Other - Org Name:PINEYWOODS MOBILE MED
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:936-395-0825
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:BEDIAS
Mailing Address - State:TX
Mailing Address - Zip Code:77831-0475
Mailing Address - Country:US
Mailing Address - Phone:936-395-0825
Mailing Address - Fax:
Practice Address - Street 1:25523 BANKHEAD DR
Practice Address - Street 2:
Practice Address - City:BEDIAS
Practice Address - State:TX
Practice Address - Zip Code:77831
Practice Address - Country:US
Practice Address - Phone:936-395-0825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty