Proliance Surgeons, Inc., P.S.
Organization Active NPI Otolaryngology Physician · Edmonds, WA
NPI 1770764342 · NPPES record last updated Nov 1, 2022
Key facts
- NPI
- 1770764342
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- License
- 601484763 (WA)
- Legal business name
- PROLIANCE SURGEONS, INC., P.S.
- Practice address
- 21911 76TH Ave W Ste 211
Edmonds, WA 98026-7918 - Phone
- (425) 775-6651
- Fax
- (425) 670-6718
- NPI assigned
- Nov 23, 2007
- Organization subpart
- No
Authorized official
- Name
- Cori M. Pleasant
- Title
- MGR Provider Relations/Enrollment
- Phone
- (206) 838-2585
Practitioners 11
-
Leah Joyce Alvis, AUD, CCC-A
-
Matthew Bartindale, M.D.
-
Laura Elizabeth Jackson, PA-C
-
Erin Elizabeth Lazar, AU.D.
-
Daniel Junho Lee, MD
-
Lisa Marie Mulligan, M.D.
-
Duncan A Riddell, M.D.
-
Jeffrey M Singh, D.O.
-
Alex Joseph Fejta Tampio, M.D.
-
Michael J Young, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031119000128 | WA | Part B Supplier - Clinic/Group Practice | 8527972900 |
Receives reassigned benefits from 781 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
515 Minor Ave
Ste 150
Seattle, WA 98104
Phone (206) 622-9916
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician |
207Y00000X | 601484763 | WA | Yes |
| Otology & Neurotology Physician |
207YX0901X | |||
| Audiologist |
231H00000X | 601484763 | WA | |
| Multi-Specialty Clinic/Center | 261QM1300X |
Addresses
Primary practice location
21911 76TH Ave W Ste 211
Edmonds, WA 98026-7918
Mailing address
21911 76TH Ave W Ste 211
Edmonds, WA 98026-7918
Phone (425) 775-6651
Other practice location 1
515 Minor Ave Ste 140
Seattle, WA 98104-2138
Phone (425) 775-6651
Other practice location 2
13020 Meridian Ave S Fl 2
Everett, WA 98208-6468
Phone (425) 775-6651
Other practice location 3
104 27th Ave SE
Puyallup, WA 98374-1145
Phone (425) 775-6651
Other practice location 4
515 Minor Ave Ste 150
Seattle, WA 98104-2144
Phone (425) 775-6651
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 227718 | Other | WA | LABOR & INDUSTRIES |
| 1060556 | Medicaid | WA |
Other names
- Proliance Surgeons Puget Sound ENT
Other providers in Edmonds, WA
- 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
- Martin Proudfoot
- Psychiatry Evergreen PLLC
- Public Hosp Dist 2 of Snoh County
- Public Hosp District #2 of Snoh County
- Public Hospital District #2 of Snohomish County
All providers in Edmonds, WA · Otolaryngology Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.