Healthcare Provider Details

I. General information

NPI: 1346289428
Provider Name (Legal Business Name): PROLIANCE SURGEONS, INC., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 N 45TH ST
SEATTLE WA
98103-6907
US

IV. Provider business mailing address

2409 N 45TH ST
SEATTLE WA
98103-6907
US

V. Phone/Fax

Practice location:
  • Phone: 206-633-8100
  • Fax: 206-633-6073
Mailing address:
  • Phone: 206-633-8100
  • Fax: 206-633-6073

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