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General NPI Number Information
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NPI Number | 1669411617
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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 | 06/05/2006
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 12911 120TH AVE NE STE H210
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City | KIRKLAND
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State | WA
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Zip | 98034-3065
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Country | US
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Telephone | 425-823-4000
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Fax | 425-821-3550
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Provider Business Mailing Address
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Address Line | 12911 120TH AVE NE STE G10
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City | KIRKLAND
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State | WA
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Zip | 98034-3048
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Country | US
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Telephone | 206-823-4000
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Fax | 206-821-3550
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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 | 261Q00000X
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Taxonomy Name | 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 | 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 #3
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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 #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 601484763
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License Number State | WA
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