# PROLIANCE SURGEONS INC PS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Minor and James Endoscopy Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891776233
- **Authorized official:** MR. DAVID G FITZGERALD (CEO)
- **Authorized official phone:** (206) 838-2599

## Contact information

- **Practice address:** 515 MINOR AVE, SUITE 200, SEATTLE, WA 98104-2120
- **Practice address phone:** (206) 386-9515
- **Practice address fax:** (206) 576-3807
- **Mailing address:** 805 MADISON ST, SUITE 901, SEATTLE, WA 98104-1172
- **Mailing address phone:** (206) 264-8100

## Taxonomy

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

## Other

- **Enumeration date:** 11/11/2005
- **Last updated:** 04/05/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 163569 | LABOR & INDUSTRIES | WA |
| 01 | — | 490001094 | PALMETTO RR MEDICARE | WA |
| 01 | — | 5891740001 | DME | WA |
| 05 | — | 7027352 | — | WA |
| 01 | — | MI4993 | REGENCE | WA |