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General NPI Number Information
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NPI Number | 1184140477
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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 | 08/17/2017
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 6808 220TH ST SW STE 105
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-2187
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Country | US
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Telephone | 425-967-6490
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Fax | 425-967-6495
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Provider Business Mailing Address
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Address Line | 7320 216TH ST SW STE 320
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City | EDMONDS
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State | WA
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Zip | 98026-8006
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Country | US
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Telephone | 425-673-3900
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Fax |
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Authorized Official
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Title or Position | MGR PROVIDER RELATIONS/ENROLLMENT
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Name | CORI M. PLEASANT
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Credential |
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Telephone | 206-838-2585
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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 | 601484763
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License Number State | WA
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