Healthcare Provider Details

I. General information

NPI: 1114479375
Provider Name (Legal Business Name): PLAINS ANESTHESIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 07/09/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 UNIVERSITY DR S ROUTE 1707
FARGO ND
58103-5810
US

IV. Provider business mailing address

1720 UNIVERSITY DR S ROUTE 1707
FARGO ND
58103-6104
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-1728
  • Fax: 701-234-1681
Mailing address:
  • Phone: 701-234-1728
  • Fax: 701-234-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: NAGESWARARAO V CHALASANI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 701-234-1728