Proliance Surgeons, Inc., P.S.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

601484763 Issued in WA

Legal business name

PROLIANCE SURGEONS, INC., P.S.

Practice address

6520 226TH PL SE
Suite 205
Issaquah, WA 98027-8969

Phone

(425) 392-8611

Fax

(425) 392-9012

NPI assigned

Dec 3, 2014

Organization subpart

No

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

Authorized official

Name

Mr. David G. Fitzgerald

Title

Ceo

Phone

(206) 838-2599

Specialties & licenses 2

Addresses

Other names 1

• Athena Women's Health Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregory A Komenda, M.D.

  • Orthopaedic Surgery Physician
  • Bellevue, WA
  • NPI 1972562528
  NPD

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1467859645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 MADISON ST",
            "address_2": "SUITE 901",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041172",
            "telephone_number": "206-264-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6520 226TH PL SE",
            "address_2": "SUITE 205",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278969",
            "telephone_number": "425-392-8611",
            "fax_number": "425-392-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "FITZGERALD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "206-838-2599",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": "WA",
            "license": "601484763",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "601484763",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Athena Women's Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Proliance Surgeons Inc P S
• Proliance Surgeons Inc., P.S.
• Proliance Surgeons Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Proliance Surgeons, Inc., P.S.
• Cheyanne Prominski, MSW
• Providence Health & Services Washington
• Kim Elizabeth Pruess Nevins, MD
• Misty Leigh Pruner, OTR

• Urology Physician in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Urology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.