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	261QA1903X	Ambulatory Surgical Clinic/Center	601484763	WA

General Provider Information

NPI Number	:	1750321006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROLIANCE SURGEONS, INC., P.S.

Provider Business Mailing Address
First Line	:	4033 TALBOT RD S STE 270
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98055-5767
Country	:	US
Telephone Number	:	425-226-2041
Fax Number	:

Provider Business Practice Location Address
First Line	:	4033 TALBOT RD S STE 270
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98055-5767
Country	:	US
Telephone Number	:	425-226-2041
Fax Number	:	425-226-2405

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	05/28/2021

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