MEDICARE: PROLIANCE SURGEONS INC P S

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	261QM1300X	Multi-Specialty Clinic/Center
2	207X00000X	Orthopaedic Surgery Physician	601484763	WA
3	363AS0400X	Surgical Physician Assistant
4	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	49718	OTHER	WA	WA LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1023170313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROLIANCE SURGEONS INC P S

Provider Business Mailing Address
First Line	:	2409 N 45TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6907
Country	:	US
Telephone Number	:	206-633-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 TALLMAN AVE NW STE 500
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-5902
Country	:	US
Telephone Number	:	206-784-8833
Fax Number	:	206-784-0676

Authorized Official
Title or Position	:	MGR PROVIDER RELATIONS/ENROLLMENT
Name	:	CORI M. PLEASANT
Credential	:
Telephone Number	:	206-838-2585

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	11/12/2024

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Directions to “PROLIANCE SURGEONS INC P S ” Practice Location

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