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Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
Puyallup Ambulatory Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA KLEISLE (CHIEF RISK OFFICER)
(206) 838-2590
Entity
Organization
Contact information
Practice address
1519 3RD ST SE, SUITE 240, PUYALLUP, WA 98372-3742
(253) 445-1844
Mailing address
1519 3RD ST SE STE 210, PUYALLUP, WA 98372-3742
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2041039
—
WA
01
—
334863
WA LABOR & INDUSTRIES
WA
Enumeration date
08/04/2006
Last updated
05/27/2021
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