Cesar Enrique Guerrero MD Faad PA

Key facts

NPI: 1942976378
Entity type: Organization (NPI type 2)
Primary specialty: MOHS-Micrographic Surgery Physician 207ND0101X
Legal business name: CESAR ENRIQUE GUERRERO MD FAAD PA
Practice address: 80 S Main St
Grenada, MS 38901-2620
Phone: (662) 307-9030
Fax: (662) 307-9038
NPI assigned: Aug 17, 2021
Organization subpart: No

Authorized official

Name: Dr. Cesar E Guerrero, MD
Title: Ceo
Phone: (662) 307-9030

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Cesar Enrique Guerrero, MD Dermatology Physician · Grenada, MS · NPI 1720378169

Medicare reassignment NPD MS · SINGLE SPECIALTY · TN
Radoslaw Filip Bieniek, M.D. Dermatopathology (Pathology) Physician · Greensboro, NC · NPI 1083853006

NPD

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
25D2262095	Grenada Dermatology 80 S Main St, Grenada, MS 38901	Compliance	Jan 11, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled (2 enrollments) in TN, MS

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20210909003584	TN	Part B Supplier - Clinic/Group Practice	9830595214	Receives reassigned benefits from 1 practitioner Practice locations: Cordova, TN
O20220420000266	MS	Part B Supplier - Clinic/Group Practice	9830595214	Receives reassigned benefits from 1 practitioner Practice locations: Grenada, MS

National Provider Directory

Locations

80 S Main St
Grenada, MS 38901
Phone (662) 307-9030

751 Walnut Knoll Ln
Ste 100
Cordova, TN 38018
Phone (731) 903-7205

Specialties & licenses

Specialty (taxonomy)	Code	Primary
Dermatology Physician Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	207N00000X
MOHS-Micrographic Surgery Physician Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	207ND0101X	Yes
Dermatopathology Physician Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	207ND0900X
Procedural Dermatology Physician Group: 193200000X MULTI-SPECIALTY GROUP	207NS0135X

Addresses

Primary practice location

80 S Main St
Grenada, MS 38901-2620

Mailing address

80 S Main St
Grenada, MS 38901-2620
Phone (662) 307-9030

Other names

Grenada Dermatology Doing business as

Other providers in Grenada, MS

Mickey Alan Cannon
Cardiovascular Solutions of Mississippi, LLC
Linda Gail Carter, AGNP-C
Richard Dean Cash, RPH
Diana Rochelle Cashaw, RN
Blenda H Chambley, FNP
Chaney'S Pharmacy of Grenada, Inc.
Chaneys Pharmacy of Grenada Inc
Childrens Health Clinic
Sherry B Chrestman, FNP-C

All providers in Grenada, MS · MOHS-Micrographic Surgery Physician in Mississippi

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.