Organization
PROLIANCE SURGEONS INC., P.S.
Active
Other names
Proliance Surgical Specialists of Edmonds
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
7320 216TH ST SW STE 20, EDMONDS, WA 98026-8006
(425) 778-8116
(425) 775-9526
Mailing address
7320 216TH ST SW STE 20, EDMONDS, WA 98026-8006
(425) 778-8116
(425) 775-9626
Taxonomy
Speciality
Code
Description
License number
State
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
208600000X
Surgery Physician
601484763
WA
208600000X
Surgery Physician
Primary
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1042735
—
WA
01
—
156966
WA LABOR & INDUSTRIES
WA
01
—
700164800
OWCP
WA
Enumeration date
06/27/2006
Last updated
06/21/2024
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