Provider Demographics
NPI:1427226125
Name:NORTHERN FACIAL SURGEONS, P.C.
Entity Type:Organization
Organization Name:NORTHERN FACIAL SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHMALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-255-4000
Mailing Address - Street 1:2331 TYLER PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0871
Mailing Address - Country:US
Mailing Address - Phone:701-255-4000
Mailing Address - Fax:701-255-1992
Practice Address - Street 1:2331 TYLER PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0871
Practice Address - Country:US
Practice Address - Phone:701-255-4000
Practice Address - Fax:701-255-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14755Medicaid
ND41455Medicaid