Provider Demographics
NPI:1316413958
Name:PEDS CENTER OF ROUND ROCK PA
Entity Type:Organization
Organization Name:PEDS CENTER OF ROUND ROCK PA
Other - Org Name:PEDIATRIC CARE OF AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVEKANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:DASARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-289-7621
Mailing Address - Street 1:1015 E 32ND ST STE 203
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2700
Mailing Address - Country:US
Mailing Address - Phone:512-476-5437
Mailing Address - Fax:512-476-0961
Practice Address - Street 1:1015 E 32ND ST STE 203
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2700
Practice Address - Country:US
Practice Address - Phone:512-476-5437
Practice Address - Fax:512-476-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty