Organization
PROLIANCE SURGEONS INC PS
Active
Other names
Minor and James Endoscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID G FITZGERALD (CEO)
(206) 838-2599
Entity
Organization
Contact information
Practice address
515 MINOR AVE, SUITE 200, SEATTLE, WA 98104-2120
(206) 386-9515
(206) 576-3807
Mailing address
805 MADISON ST, SUITE 901, SEATTLE, WA 98104-1172
(206) 264-8100
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
601484763
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
163569
LABOR & INDUSTRIES
WA
01
—
490001094
PALMETTO RR MEDICARE
WA
01
—
5891740001
DME
WA
05
—
7027352
—
WA
01
—
MI4993
REGENCE
WA
Enumeration date
11/11/2005
Last updated
04/05/2016
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