Healthcare Provider Details

I. General information

NPI: 1124748249
Provider Name (Legal Business Name): DELL CHILDREN'S MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 N LAKE CREEK PKWY BLDG 2 SUITE 101
AUSTIN TX
78717
US

IV. Provider business mailing address

1345 PHILOMENA ST SUITE 410.3
AUSTIN TX
78723
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-1800
  • Fax:
Mailing address:
  • Phone: 512-324-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLAYTON CARSNER
Title or Position: VP / COO
Credential:
Phone: 512-324-5846