Healthcare Provider Details

I. General information

NPI: 1447339916
Provider Name (Legal Business Name): PINEYWOODS DIAGNOSTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9423 S US HIGHWAY 69
HUNTINGTON TX
75949-1515
US

IV. Provider business mailing address

PO BOX 1297
HUNTINGTON TX
75949-1297
US

V. Phone/Fax

Practice location:
  • Phone: 936-876-5719
  • Fax: 936-876-3308
Mailing address:
  • Phone: 936-876-5719
  • Fax: 936-876-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberJ9263
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF8981
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberF8981
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ9263
License Number StateTX

VIII. Authorized Official

Name: DR. LENIN PINNAMANENI
Title or Position: PARTNER
Credential: MD
Phone: 936-876-5719