Provider Demographics
NPI:1184815227
Name:PEDIATRIC SURGICAL SUBSPECIALISTS
Entity Type:Organization
Organization Name:PEDIATRIC SURGICAL SUBSPECIALISTS
Other - Org Name:PEDIATRIC NEUROSURGERY CENTER OF CENTRAL TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MAXSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-324-8068
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3080
Mailing Address - Country:US
Mailing Address - Phone:512-324-9999
Mailing Address - Fax:512-324-0643
Practice Address - Street 1:1301 BARBARA JORDAN BLVD STE 307
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3080
Practice Address - Country:US
Practice Address - Phone:512-324-9999
Practice Address - Fax:512-324-0643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y420OtherMEDICARE PTAN