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Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
Orthopedic Physician Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA KLEISLE (CHIEF RISK OFFICER)
(206) 838-2590
Entity
Organization
Contact information
Practice address
3216 NE 45TH PL STE 304, SEATTLE, WA 98105-4028
(206) 386-2600
(206) 622-1644
Mailing address
601 BROADWAY FL 6, SEATTLE, WA 98122-5330
(206) 386-2600
(206) 622-1644
Taxonomy
Speciality
Code
Description
License number
State
2080S0010X
Pediatric Sports Medicine Physician
Primary
601484763
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2021639
—
WA
01
—
49701
WA LABOR & INDUSTRIES
WA
Enumeration date
04/02/2015
Last updated
05/27/2021
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