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Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
Proliance Eastside 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
12911 120TH AVE NE STE H110, KIRKLAND, WA 98034-3061
(425) 216-7000
(425) 216-7019
Mailing address
12911 120TH AVE NE STE G10, KIRKLAND, WA 98034-3048
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
601484763
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1045664
—
WA
01
—
173398
WA LABOR & INDUSTRIES
—
Enumeration date
06/05/2006
Last updated
05/28/2021
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