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
1	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
3	261QM1300X	Multi-Specialty Clinic/Center
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	363AS0400X	Surgical Physician Assistant
6	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0532700022	OTHER	WA	DME
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	218643	OTHER	WA	WA L&I

General Provider Information

NPI Number	:	1952399123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROLIANCE SURGEONS, INC., P.S.

Provider Business Mailing Address
First Line	:	3801 5TH ST SE STE 110
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98374-2106
Country	:	US
Telephone Number	:	253-845-9585
Fax Number	:	253-848-1126

Provider Business Practice Location Address
First Line	:	3801 5TH ST SE STE 110
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98374-2106
Country	:	US
Telephone Number	:	253-845-9585
Fax Number	:	253-435-4785

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/22/2022

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

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