Healthcare Provider Details

I. General information

NPI: 1144748286
Provider Name (Legal Business Name): PINEYWOODS PAIN ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W FRANK AVE ANESTHESIA DEPARTMENT
LUFKIN TX
75904-3357
US

IV. Provider business mailing address

PO BOX 155721
LUFKIN TX
75915-5721
US

V. Phone/Fax

Practice location:
  • Phone: 936-639-3036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN DALE HARRIS
Title or Position: MEMBER
Credential: MD
Phone: 936-559-3783