Healthcare Provider Details

I. General information

NPI: 1457891426
Provider Name (Legal Business Name): PROLIANCE SURGEONS, INC., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6808 220TH ST SW STE 100
MOUNTLAKE TERRACE WA
98043-2187
US

IV. Provider business mailing address

6808 220TH ST SW STE 100
MOUNTLAKE TERRACE WA
98043-2187
US

V. Phone/Fax

Practice location:
  • Phone: 425-921-6500
  • Fax: 425-921-6505
Mailing address:
  • Phone: 425-921-6500
  • Fax: 425-921-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number601484763
License Number StateWA

VIII. Authorized Official

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