Proliance Surgeons, Inc., P.S.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

601484763 Issued in WA

Legal business name

PROLIANCE SURGEONS, INC., P.S.

Doing business as

Evergreen Surgical Clinic

Practice address

12333 NE 130TH LN
Suite 420
Kirkland, WA 98034-7467

Phone

(425) 899-5500

Fax

(425) 899-5529

NPI assigned

Jun 1, 2006

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 1

Addresses

Other names 1

• Evergreen Surgical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1487691150",
    "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",
            "fax_number": "206-264-8689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12333 NE 130TH LN",
            "address_2": "SUITE 420",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347467",
            "telephone_number": "425-899-5500",
            "fax_number": "425-899-5529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2011-10-31",
        "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": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "WA",
            "license": "601484763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Surgical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Olga Prokazova
• Proliance Surgeons Inc P S (Proliance Hand, Wrist and Elbow Physicians)
• Proliance Surgeons Inc P S (Proliance ProOrtho Orthopedics Sports, Joints and Spine)
• Proliance Surgeons, Inc., P.S. (Proliance Eastside Physical Therapy)
• Proliance Surgeons, Inc., P.S. (Proliance Eastside MRI)
• Proliance Surgeons, Inc., P.S. (Proliance Eastside ENT)
• Proliance Surgeons, Inc., P.S. (Proliance Eastside Surgery Center)
• Proliance Surgeons, Inc., P.S. (Evergreen Surgical Clinic Ambulatory Surgery Center)
• Joseph A Pronk, PT
• Prosthetic Specialists of Washington

• Surgery Physician in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; 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.