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General NPI Number Information
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NPI Number | 1255736971
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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 | 10/23/2014
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 1519 3RD ST SE STE 210
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City | PUYALLUP
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State | WA
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Zip | 98372-3742
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Country | US
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Telephone | 253-840-4994
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Fax | 253-770-1105
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Provider Business Mailing Address
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Address Line | 1519 3RD ST SE STE 210
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City | PUYALLUP
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State | WA
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Zip | 98372-3742
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Country | US
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Telephone | 253-840-4994
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Fax | 253-770-1105
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 601484763
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 601484763
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 601484763
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty 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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 601484763
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License Number State | WA
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