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General NPI Number Information
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NPI Number | 1972565745
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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 | 04/05/2006
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 3801 5TH ST SE STE 210
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City | PUYALLUP
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State | WA
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Zip | 98374-2106
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Country | US
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Telephone | 253-445-4285
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Fax | 253-435-4783
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Provider Business Mailing Address
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Address Line | 3801 5TH ST SE STE 110
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City | PUYALLUP
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State | WA
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Zip | 98374-2106
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Country | US
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Telephone | 253-845-9585
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Fax |
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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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