Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
Proliance Surgeons Skagit Northwest Orthopedics/Physical Therapy
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
1500 CONTINENTAL PL, MOUNT VERNON, WA 98273-4105
(360) 424-7041
(360) 424-2418
Mailing address
1401 S LAVENTURE RD, MOUNT VERNON, WA 98274-6033
(360) 424-7041
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
601484763
WA
208100000X
Physical Medicine & Rehabilitation Physician
601484763
WA
213ES0103X
Foot & Ankle Surgery Podiatrist
601484763
WA
225100000X
Physical Therapist
601484763
WA
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363AS0400X
Surgical Physician Assistant
601484763
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1042545
—
WA
01
—
121724
WA LABOR & INDUSTRIES
WA
Enumeration date
12/09/2013
Last updated
08/25/2022
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