Provider Demographics
NPI:1497959373
Name:PEDIATRIC CARE OF AUSTIN, PA
Entity Type:Organization
Organization Name:PEDIATRIC CARE OF AUSTIN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:CANTU
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-476-5437
Mailing Address - Street 1:1015 E 32ND ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2707
Mailing Address - Country:US
Mailing Address - Phone:512-733-5437
Mailing Address - Fax:512-476-0960
Practice Address - Street 1:1015 E 32ND ST
Practice Address - Street 2:SUITE 203
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2707
Practice Address - Country:US
Practice Address - Phone:512-733-5437
Practice Address - Fax:512-476-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091851802Medicaid
TX091851801Medicaid
TX091851801Medicaid