MEDICARE: JOHN E PINKSTAFF M D PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1568905610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN E PINKSTAFF M D PLLC

Provider Business Mailing Address
First Line	:	17472 CREEK XING
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-5523
Country	:	US
Telephone Number	:	409-256-5817
Fax Number	:

Provider Business Practice Location Address
First Line	:	193 INTERSTATE 45 S STE 800
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340
Country	:	US
Telephone Number	:	409-256-5817
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. JOHN EDMOND PINKSTAFF
Credential	:	M.D.
Telephone Number	:	409-256-5817

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	11/22/2016

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