Organization
PROLIANCE SURGEONS INC PS
Active
Other names
Plastic & Reconstructive Surgeons ASC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA KLEISLE (CHIEF RISK OFFICER)
(206) 838-2590
Entity
Organization
Contact information
Practice address
17930 TALBOT RD S, RENTON, WA 98055-6230
(425) 228-3187
(425) 228-7972
Mailing address
17930 TALBOT RD S, RENTON, WA 98055-6230
(425) 228-3187
(425) 228-7972
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
344913
WA LABOR & INDUSTRIES
WA
Enumeration date
06/30/2008
Last updated
05/27/2021
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