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General NPI Number Information
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NPI Number | 1295775369
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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 | 06/07/2006
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 7320 216TH ST SW STE 140
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City | EDMONDS
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State | WA
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Zip | 98026-8028
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Country | US
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Telephone | 206-673-3750
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Fax | 206-673-3763
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Provider Business Mailing Address
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Address Line | 7320 216TH ST SW STE 140
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City | EDMONDS
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State | WA
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Zip | 98026-8028
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Country | US
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Telephone | 425-673-3750
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Fax | 425-673-3763
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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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