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General NPI Number Information
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NPI Number | 1578801718
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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 | 01/23/2013
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 1231 116TH AVE NE STE 930
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City | BELLEVUE
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State | WA
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Zip | 98004-3804
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Country | US
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Telephone | 425-668-1916
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Fax | 425-688-1901
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Provider Business Mailing Address
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Address Line | 1231 116TH AVE NE STE 930
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City | BELLEVUE
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State | WA
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Zip | 98004-3804
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Country | US
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Telephone | 425-668-1916
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Fax | 425-688-1901
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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 | 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 #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology 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 | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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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 | 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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