Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
Proliance Rainier Orthopedic Institute, Proliance ProSports Imaging NW MRI
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
3801 5TH ST SE STE 110, PUYALLUP, WA 98374-2106
(253) 845-9585
(253) 435-4785
Mailing address
3801 5TH ST SE STE 110, PUYALLUP, WA 98374-2106
(253) 845-9585
(253) 848-1126
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0532700022
DME
WA
05
—
1046356
—
WA
01
—
218643
WA L&I
WA
Enumeration date
10/11/2005
Last updated
08/22/2022
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