Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
ProSports Imaging NW MRI
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA KLEISLE (CHIEF RISK OFFICER)
(206) 838-2590
Entity
Organization
Contact information
Practice address
3801 5TH ST SE, SUITE 120, PUYALLUP, WA 98374-2103
(253) 864-4106
(253) 864-4143
Mailing address
3801 5TH ST SE STE 110, PUYALLUP, WA 98374-2106
(253) 845-9585
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Enumeration date
07/14/2021
Last updated
07/14/2021
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