Provider Demographics
NPI:1588764955
Name:PINEYWOODS PATHOLOGY PA
Entity type:Organization
Organization Name:PINEYWOODS PATHOLOGY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-639-7886
Mailing Address - Street 1:PO DRAWER 1906
Mailing Address - Street 2:821 W FRANK AVE
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75902-1906
Mailing Address - Country:US
Mailing Address - Phone:936-639-5474
Mailing Address - Fax:936-639-5487
Practice Address - Street 1:1201 W FRANK
Practice Address - Street 2:MEMORIAL MEDICAL CENTER
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-639-7886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1679557-01Medicaid
00534WMedicare ID - Type Unspecified
CJ9833Medicare ID - Type UnspecifiedRAILROAD