# PROLIANCE SURGEONS, INC., P.S.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Orthopedic Physician Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134514433
- **Authorized official:** MRS. LAURA KLEISLE (CHIEF RISK OFFICER)
- **Authorized official phone:** (206) 838-2590

## Contact information

- **Practice address:** 3216 NE 45TH PL STE 304, SEATTLE, WA 98105-4028
- **Practice address phone:** (206) 386-2600
- **Practice address fax:** (206) 622-1644
- **Mailing address:** 601 BROADWAY FL 6, SEATTLE, WA 98122-5330
- **Mailing address phone:** (206) 386-2600
- **Mailing address fax:** (206) 622-1644

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080S0010X | Pediatric Sports Medicine Physician | 601484763 | WA | Yes |

## Other

- **Enumeration date:** 04/02/2015
- **Last updated:** 05/27/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2021639 | — | WA |
| 01 | — | 49701 | WA LABOR & INDUSTRIES | WA |