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General NPI Number Information
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NPI Number | 1134514433
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Entity Type | Organization
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Legal Business Name | PROLIANCE SURGEONS, INC., P.S.
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 3216 NE 45TH PL STE 304
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City | SEATTLE
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State | WA
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Zip | 98105-4028
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Country | US
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Telephone | 206-386-2600
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Fax | 206-622-1644
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Provider Business Mailing Address
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Address Line | 601 BROADWAY FL 6
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City | SEATTLE
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State | WA
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Zip | 98122-5330
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Country | US
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Telephone | 206-386-2600
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Fax | 206-622-1644
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Authorized Official
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Title or Position | CHIEF RISK OFFICER
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Name | MRS. LAURA KLEISLE
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Credential |
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Telephone | 206-838-2590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number | 601484763
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License Number State | WA
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