Provider Demographics
NPI:1194727883
Name:PROLIANCE SURGEONS, INC., P.S.
Entity type:Organization
Organization Name:PROLIANCE SURGEONS, INC., P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:7308 BRIDGEPORT WAY W STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8000
Mailing Address - Country:US
Mailing Address - Phone:253-584-5252
Mailing Address - Fax:253-582-1617
Practice Address - Street 1:7308 BRIDGEPORT WAY W STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8000
Practice Address - Country:US
Practice Address - Phone:253-584-5252
Practice Address - Fax:253-582-1617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROLIANCE SURGEONS, INC. P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-11
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
WA1043206Medicaid
WA223794OtherWA LABOR & INDUSTRIES
612815300OtherOWCP