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General NPI Number Information
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NPI Number | 1164461182
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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 | 06/05/2006
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 12911 120TH AVE NE SUITE H-120
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City | KIRKLAND
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State | WA
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Zip | 98034-3027
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Country | US
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Telephone | 425-823-4226
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Fax | 425-823-4754
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Provider Business Mailing Address
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Address Line | 12911 120TH AVE NE STE G10
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City | KIRKLAND
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State | WA
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Zip | 98034-3048
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Country | US
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Telephone | 425-481-6301
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2471M1202X
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Taxonomy Name | Magnetic Resonance Imaging Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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