# PROLIANCE SURGEONS, INC., P.S

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Edmonds Orthopedic Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326564790
- **Authorized official:** MRS. LAURA KLEISLE (CHIEF RISK OFFICER)
- **Authorized official phone:** (206) 838-2590

## Contact information

- **Practice address:** 6808 220TH ST SW STE 200, MOUNTLAKE TERRACE, WA 98043-2187
- **Practice address phone:** (425) 967-6480
- **Practice address fax:** (425) 967-6485
- **Mailing address:** 805 MADISON ST STE 901, SEATTLE, WA 98104-1172

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 601484763 | WA | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | 601484763 | WA | — |
| 207XS0114X | Adult Reconstructive Orthopaedic Surgery Physician | 601484763 | WA | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | 601484763 | WA | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | 601484763 | WA | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | 601484763 | WA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 601484763 | WA | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |

## Other

- **Enumeration date:** 08/17/2017
- **Last updated:** 07/21/2022