1578663563 NPI number — PEDIATRIC CENTER OF ROUND ROCK

Table of content: MS. SUSAN ANN BUCKLEY OTR (NPI 1306016316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578663563 NPI number — PEDIATRIC CENTER OF ROUND ROCK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC CENTER OF ROUND ROCK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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 Information

NPI Number:
1578663563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7700 CAT HOLLOW DR
Provider Second Line Business Mailing Address:
UNIT 104
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78681-5796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-733-5437
Provider Business Mailing Address Fax Number:
512-244-1861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 CAT HOLLOW DR
Provider Second Line Business Practice Location Address:
UNIT 104
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78681-5796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-733-5437
Provider Business Practice Location Address Fax Number:
512-244-1861
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KATALENAS
Authorized Official First Name:
MARTA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
512-733-5437

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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