Provider Demographics
NPI:1174737134
Name:CENTRAL TEXAS PLASTIC SURGERY PA
Entity type:Organization
Organization Name:CENTRAL TEXAS PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-244-3755
Mailing Address - Street 1:7215 WYOMING SPGS
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4312
Mailing Address - Country:US
Mailing Address - Phone:512-244-3755
Mailing Address - Fax:512-244-9318
Practice Address - Street 1:7215 WYOMING SPGS
Practice Address - Street 2:SUITE 200
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4312
Practice Address - Country:US
Practice Address - Phone:512-244-3755
Practice Address - Fax:512-244-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131785106Medicaid
TX131785106Medicaid
TXE97714Medicare UPIN