Healthcare Provider Details

I. General information

NPI: 1972565745
Provider Name (Legal Business Name): PROLIANCE SURGEONS INC P S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 5TH ST SE STE 210
PUYALLUP WA
98374-2106
US

IV. Provider business mailing address

3801 5TH ST SE STE 110
PUYALLUP WA
98374-2106
US

V. Phone/Fax

Practice location:
  • Phone: 253-445-4285
  • Fax: 253-435-4783
Mailing address:
  • Phone: 253-845-9585
  • Fax:

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