Provider Demographics
NPI:1659598068
Name:GLENN WOOD MD PA
Entity Type:Organization
Organization Name:GLENN WOOD MD PA
Other - Org Name:CAROUSEL PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-744-6000
Mailing Address - Street 1:7112 ED BLUESTEIN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2900
Mailing Address - Country:US
Mailing Address - Phone:512-744-6000
Mailing Address - Fax:512-744-6010
Practice Address - Street 1:7112 ED BLUESTEIN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2900
Practice Address - Country:US
Practice Address - Phone:512-744-6000
Practice Address - Fax:512-744-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153715101Medicaid
TX153715102Medicaid