# PROLIANCE SURGEONS, INC., P.S.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Proliance Eastside Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790724862
- **Authorized official:** MRS. LAURA KLEISLE (CHIEF RISK OFFICER)
- **Authorized official phone:** (206) 838-2590

## Contact information

- **Practice address:** 12911 120TH AVE NE STE H110, KIRKLAND, WA 98034-3061
- **Practice address phone:** (425) 216-7000
- **Practice address fax:** (425) 216-7019
- **Mailing address:** 12911 120TH AVE NE STE G10, KIRKLAND, WA 98034-3048

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 601484763 | WA | Yes |

## Other

- **Enumeration date:** 06/05/2006
- **Last updated:** 05/28/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1045664 | — | WA |
| 01 | — | 173398 | WA LABOR & INDUSTRIES | — |