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Organization
PROLIANCE SURGEONS, INC., P.S
Active
Organization
PROLIANCE SURGEONS, INC., P.S
Active
Other names
Proliance Surgeons Ankle and Foot of Edmonds
Organization subpart
No
Provider details
NPI number
Authorized official
CORI M. PLEASANT (MGR PROVIDER RELATIONS/ENROLLMENT)
(206) 838-2585
Entity
Organization
Contact information
Practice address
7320 216TH ST SW STE 320B, EDMONDS, WA 98026-8006
(425) 775-6996
(425) 670-8905
Mailing address
7320 216TH ST SW STE 320, EDMONDS, WA 98026-8006
(425) 673-3900
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
NULL
213E00000X
Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
601484763
WA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
NULL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0532700039
NSC DME
WA
05
—
1043983
—
WA
01
—
49391
WA LABOR & INDUSTRIES
WA
Enumeration date
02/16/2018
Last updated
08/18/2022
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