MEDICARE: C. GUY FPS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YS0123X	Facial Plastic Surgery Physician	P0727	TX

General Provider Information

NPI Number	:	1558872952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C. GUY FPS, PLLC

Provider Business Mailing Address
First Line	:	100 W CENTRAL TEXAS EXPY STE 210
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-7469
Country	:	US
Telephone Number	:	254-618-4933
Fax Number	:	254-618-1191

Provider Business Practice Location Address
First Line	:	1129 ABERDEEN RD
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712
Country	:	US
Telephone Number	:	245-845-1221
Fax Number	:	254-618-1191

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES W GUY
Credential	:	MD
Telephone Number	:	254-405-6163

Provider Enumeration Date	:	10/12/2017
Last Update Date	:	08/24/2018

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