1790103869 NPI number — DELL CHILDREN'S MEDICAL GROUP

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790103869 NPI number — DELL CHILDREN'S MEDICAL GROUP

Employer Identification Number (EIN):

Provider Organization Name:

DELL CHILDREN'S MEDICAL GROUP

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

'SPECIALLY FOR CHILDREN CHILDREN'S HOSPITAL SUBSPECIALISTS OF CENTRAL

Provider Other Organization Name Type Code:

4

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1790103869

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

06/27/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1301 BARBARA JORDAN BLVD

Provider Second Line Business Mailing Address:

SUITE 200

Provider Business Mailing Address City Name:

AUSTIN

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

78723-3077

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

512-628-1800

Provider Business Mailing Address Fax Number:

512-628-1801

Provider First Line Business Practice Location Address:

1000 HESTERS CROSSING RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ROUND ROCK

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

78681-8020

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

512-628-1800

Provider Business Practice Location Address Fax Number:

512-628-1801

Provider Enumeration Date:

04/04/2014

Authorized Official Last Name:

CARSNER

Authorized Official First Name:

CLAYTON

Authorized Official Middle Name:

Authorized Official Title or Position:

VP/COO

Authorized Official Telephone Number:

512-324-5846

• Taxonomy code: 207NP0225X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2080H0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0205X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0207X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0210X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0216X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2084N0402X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363LP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .