Healthcare Provider Details

I. General information

NPI: 1538343033
Provider Name (Legal Business Name): PROLIANCE SURGEONS, INC., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16259 SYLVESTER RD SW STE 501
BURIEN WA
98166-3059
US

IV. Provider business mailing address

16259 SYLVESTER RD SW STE 501
BURIEN WA
98166-3059
US

V. Phone/Fax

Practice location:
  • Phone: 206-243-1100
  • Fax: 206-431-0835
Mailing address:
  • Phone: 206-243-1100
  • Fax: 206-431-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CORI M. PLEASANT
Title or Position: DEL CRED & ENROLLMENT MANAGER
Credential:
Phone: 206-838-2585