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General NPI Number Information
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NPI Number | 1194727883
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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 | 08/11/2005
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 7308 BRIDGEPORT WAY W STE 102
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City | LAKEWOOD
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State | WA
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Zip | 98499-8000
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Country | US
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Telephone | 253-584-5252
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Fax | 253-582-1617
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Provider Business Mailing Address
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Address Line | 7308 BRIDGEPORT WAY W STE 102
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City | LAKEWOOD
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State | WA
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Zip | 98499-8000
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Country | US
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Telephone | 253-584-5252
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Fax | 253-582-1617
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Authorized Official
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Title or Position | DEL CRED & ENROLLMENT MANAGER
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 601484763
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License Number State | WA
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