MEDICARE: PLAINS EAR, NOSE, THROAT & FACIAL PLASTIC SURGERY PC

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	10000	ND

General Provider Information

NPI Number	:	1003199829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAINS EAR, NOSE, THROAT & FACIAL PLASTIC SURGERY PC

Provider Business Mailing Address
First Line	:	350 23RD AVE E STE 102
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-7401
Country	:	US
Telephone Number	:	701-235-1924
Fax Number	:	701-235-6304

Provider Business Practice Location Address
First Line	:	350 23RD AVE E STE 102
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-7401
Country	:	US
Telephone Number	:	701-235-1924
Fax Number	:	701-235-6304

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LESLEY A SOINE
Credential	:	MD
Telephone Number	:	701-235-1924

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	01/03/2024

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