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	207X00000X	Orthopaedic Surgery Physician	601484763	WA
2	261QM1300X	Multi-Specialty Clinic/Center
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	49385	OTHER	WA	WA LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1134168180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROLIANCE SURGEONS INC., P.S.

Provider Business Mailing Address
First Line	:	9730 3RD AVE NE STE 201
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2023
Country	:	US
Telephone Number	:	206-526-8444
Fax Number	:	206-526-0521

Provider Business Practice Location Address
First Line	:	9730 3RD AVE NE STE 201
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2023
Country	:	US
Telephone Number	:	206-526-8444
Fax Number	:	206-526-0521

Authorized Official
Title or Position	:	CHIEF RISK OFFICER
Name	:	MRS. LAURA KLEISLE
Credential	:
Telephone Number	:	206-838-2590

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	05/27/2021

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Directions to “PROLIANCE SURGEONS INC., P.S. ” Practice Location

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