Provider Demographics
NPI:1376727214
Name:PROLIANCE SURGEONS INC PS
Entity Type:Organization
Organization Name:PROLIANCE SURGEONS INC PS
Other - Org Name:PROLIANCE SOUTHWEST SEATTLE SURGERY CENTER
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 1:275 SW 160TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3003
Mailing Address - Country:US
Mailing Address - Phone:206-988-0933
Mailing Address - Fax:
Practice Address - Street 1:275 SW 160TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3003
Practice Address - Country:US
Practice Address - Phone:206-988-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROLIANCE SURGEONS INC PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-27
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
WA228947OtherWA LABOR & INDUSTRIES
WA1021785Medicaid
613852800OtherOWCP