NPIMap

Organization Active NPI

Glenn Wood MD PA

  • Counselor
  • Austin, TX
National Provider Identifier
1073740130
Registry record updated Jun 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
GLENN WOOD MD PA
Practice address
7112 Ed Bluestein Blvd
100
Austin, TX 78723-2900
Phone
(512) 892-7200
NPI assigned
Jun 16, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Rebecca Rene Perez
Title
Credentialer
Phone
(512) 788-4801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X Primary

Addresses

Primary practice location

7112 Ed Bluestein Blvd
100
Austin, TX 78723-2900

Mailing address

6705 W Hwy 290
C1
Austin, TX 78735-8400
Phone (512) 788-4801

Other identifiers 1

IdentifierTypeStateIssuer
153715108MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Glenn Wood MD PA20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245801600000",
    "number": "1073740130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6705 W HWY 290",
            "address_2": "C1",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787358400",
            "telephone_number": "512-788-4801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7112 ED BLUESTEIN BLVD",
            "address_2": "100",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787232900",
            "telephone_number": "512-892-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN WOOD MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-16",
        "last_updated": "2009-06-24",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "CREDENTIALER",
        "authorized_official_telephone_number": "512-788-4801",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153715108",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.