Organization
PROLIANCE SURGEONS INC., P.S.
Active
Organization
PROLIANCE SURGEONS INC., P.S.
Active
Other names
Proliance ProOrtho Orthopedics, Sports, Joints and Spine
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
14841 179TH AVE SE STE 330, MONROE, WA 98272-1127
(360) 794-3300
(360) 794-6610
Mailing address
12911 120TH AVE NE STE G10, KIRKLAND, WA 98034-3048
(425) 823-4000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
601484763
WA
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1015791
—
WA
01
—
51292
WA LABOR & INDUSTRIES
—
Enumeration date
06/05/2006
Last updated
08/22/2022
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