Healthcare Provider Details

I. General information

NPI: 1386687747
Provider Name (Legal Business Name): PROLIANCE SURGEONS INC., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/21/2024
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 216TH ST SW STE 320
EDMONDS WA
98026-8006
US

IV. Provider business mailing address

7320 216TH ST SW STE 320
EDMONDS WA
98026-8006
US

V. Phone/Fax

Practice location:
  • Phone: 425-673-3900
  • Fax: 425-673-3910
Mailing address:
  • Phone: 425-673-3900
  • Fax: 206-673-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number601484763
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number601484763
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CORI M. PLEASANT
Title or Position: MGR. PROVIDER RELATIONS/ENROLLMENT
Credential:
Phone: 206-838-2585