Provider Demographics
NPI:1043581275
Name:GLENN WOOD MD PA
Entity Type:Organization
Organization Name:GLENN WOOD MD PA
Other - Org Name:CAROUSEL PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-583-9680
Mailing Address - Street 1:2621 RIDGEPOINT DR
Mailing Address - Street 2:STE 130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5232
Mailing Address - Country:US
Mailing Address - Phone:512-583-9679
Mailing Address - Fax:512-334-2321
Practice Address - Street 1:109 S TEXAS AVE
Practice Address - Street 2:STE E
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2725
Practice Address - Country:US
Practice Address - Phone:512-744-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty