Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
Proliance Surgeons Skagit Northwest Physical Therapy, Proliance Surgeons Skagit Northwest Orthopedics
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
1401 S LAVENTURE RD, MOUNT VERNON, WA 98274-6033
(360) 424-2400
(360) 424-2418
Mailing address
1401 S LAVENTURE RD, MOUNT VERNON, WA 98274-6033
(360) 424-7041
(360) 424-2418
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
601484763
WA
208100000X
Physical Medicine & Rehabilitation Physician
601484763
WA
213E00000X
Podiatrist
601484763
WA
225100000X
Physical Therapist
601484763
WA
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05327-00015
DME
WA
05
—
1042545
—
WA
01
—
121724
WA LABOR & INDUSTRIES
WA
Enumeration date
06/14/2006
Last updated
06/24/2024
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