Provider Demographics
NPI:1730198458
Name:PINEYWOODS UROLOGY, P.A.
Entity type:Organization
Organization Name:PINEYWOODS UROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-729-5067
Mailing Address - Street 1:127 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-4781
Mailing Address - Country:US
Mailing Address - Phone:903-729-5067
Mailing Address - Fax:903-729-2841
Practice Address - Street 1:127 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4781
Practice Address - Country:US
Practice Address - Phone:903-729-5067
Practice Address - Fax:903-729-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1085174400000X
TXF4004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2021FMedicare ID - Type Unspecified
TX2020FMedicare ID - Type Unspecified
TXC16208Medicare UPIN
TXD97589Medicare UPIN