Proliance Surgery Center at Valley, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PROLIANCE SURGERY CENTER AT VALLEY, LLC

Practice address

4009 Talbot Road S
Suite 200
Renton, WA 98055

Phone

(425) 226-2041

Fax

(425) 226-2402

NPI assigned

Jun 1, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Peggy Wellman

Title

VP ASC Operations

Phone

(206) 838-3767

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Listed as

Proliance Surgery Center at ValleyCCN 50C0001333

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Proliance Surgeons Inc., P.S.

  • Surgery Physician
  • Issaquah, WA
  • NPI 1639118649

  Member Of

  NPD member
• Public Hospital District 1 of King County

  • Community/Retail Pharmacy
  • Renton, WA
  • NPI 1104969518

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629417600000",
    "number": "1356965750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4011 TALBOT RD S STE 300",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980555791",
            "telephone_number": "425-226-2041",
            "fax_number": "425-226-2402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4009 TALBOT ROAD S",
            "address_2": "SUITE 200",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "98055",
            "telephone_number": "425-226-2041",
            "fax_number": "425-226-2402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGERY CENTER AT VALLEY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-01",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "WELLMAN",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "VP ASC OPERATIONS",
        "authorized_official_telephone_number": "206-838-3767"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Proliance Surgeons Inc PS
• Proliance Surgeons Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Robert F Prongay, MD
• Provascular Surgery Associates PLLC
• Providence Health & Services - Washington
• Public Hospital District #1 of King County
• Public Hospital District #1 of King County

• Ambulatory Surgical Clinic/Center in Renton, WA
• Providers in Renton, WA by specialty
• Ambulatory Surgical Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.