Provider Demographics
NPI:1609093582
Name:CAROUSEL PEDIATRICS
Entity Type:Organization
Organization Name:CAROUSEL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-892-7200
Mailing Address - Street 1:6705 W HIGHWAY 290
Mailing Address - Street 2:SUITE C1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8400
Mailing Address - Country:US
Mailing Address - Phone:512-892-7204
Mailing Address - Fax:512-892-7205
Practice Address - Street 1:6705 W HIGHWAY 290
Practice Address - Street 2:SUITE C1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8400
Practice Address - Country:US
Practice Address - Phone:512-892-7204
Practice Address - Fax:512-892-7205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty