Healthcare Provider Details

I. General information

NPI: 1811936990
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: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 TERRY AVE FL 3
SEATTLE WA
98104-4232
US

IV. Provider business mailing address

900 TERRY AVE FL 3
SEATTLE WA
98104-4232
US

V. Phone/Fax

Practice location:
  • Phone: 206-382-1021
  • Fax: 206-382-9369
Mailing address:
  • Phone: 206-382-1021
  • Fax: 206-382-1026

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: MRS. LAURA KLEISLE
Title or Position: CHIEF RISK OFFICER
Credential:
Phone: 206-838-2590