Provider Demographics
NPI:1033767975
Name:PEDS CENTER OF ROUND ROCK PA
Entity Type:Organization
Organization Name:PEDS CENTER OF ROUND ROCK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIVEKANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:DASARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-733-5437
Mailing Address - Street 1:7700 CAT HOLLOW DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5797
Mailing Address - Country:US
Mailing Address - Phone:512-733-5437
Mailing Address - Fax:512-244-1861
Practice Address - Street 1:218 W US HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-3265
Practice Address - Country:US
Practice Address - Phone:512-281-1900
Practice Address - Fax:512-285-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty