# PROLIANCE SURGEONS, INC., P.S.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Puget Sound Imaging MRI
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891364543
- **Authorized official:** MRS. LAURA KLEISLE (CHIEF RISK OFFICER)
- **Authorized official phone:** (206) 838-2590

## Contact information

- **Practice address:** 1724 W. UNION AVENUE, SUITE B-100, TACOMA, WA 98405-2099
- **Practice address phone:** (253) 830-5215
- **Practice address fax:** (253) 830-5219
- **Mailing address:** 7308 BRIDGEPORT WAY W STE 201, LAKEWOOD, WA 98499-8000
- **Mailing address phone:** (253) 582-7257

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | — |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | NULL | Yes |
| 261QR0200X | Radiology Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/17/2021
- **Last updated:** 07/09/2021