Provider Demographics
NPI:1326094491
Name:PROLIANCE SURGEONS INC PS
Entity Type:Organization
Organization Name:PROLIANCE SURGEONS INC PS
Other - Org Name:PROLIANCE CENTER FOR SPECIALTY SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEL CRED & ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:PLEASANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-838-2585
Mailing Address - Street 1:515 MINOR AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2138
Mailing Address - Country:US
Mailing Address - Phone:206-838-9500
Mailing Address - Fax:206-682-3511
Practice Address - Street 1:515 MINOR AVE STE 130
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2138
Practice Address - Country:US
Practice Address - Phone:206-838-9500
Practice Address - Fax:206-682-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601484763261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2069773Medicaid
WA353337OtherWA LABOR & INDUSTRIES
WA215831OtherLABOR & INDUSTRY
WA4545FIOtherREGENCE
WA5891740001OtherDME