PROLIANCE SURGEONS, INC., P.S. (NPI# 1528304292) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528304292 |
| Entity Type | Organization |
| Organization Name | PROLIANCE SURGEONS, INC., P.S. |
| Other Organization Name | PROLIANCE EASTSIDE ENT |
| Practice Address |
12333 Ne 130th Ln Suite 440 Kirkland WA 98034-7467 |
| Mailing Address |
805 Madison St Suite 901 Seattle WA 98104-1172 |
| Practice Telephone | 4258993838 |
| Practice Fax Number | 4256710367 |
| Mailing Telephone | 2062648100 |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2012-12-27 |
| Authorized Official Name | MR. DAVID G. FITZGERALD (CEO) |
| Authorized Official Telephone | 2068382599 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Proliance Eastside ENT | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902418189 | Proliance Surgeons, Inc., P.s. | Orthopaedic Surgery | 2727 Hollycroft St Ste 410, Gig Harbor, WA 98335-1369 | 2020-08-19 |
| 1790325710 | Proliance Surgeons, Inc., P.s. | Radiology | 1101 Madison St Ste 580, Seattle, WA 98104-4305 | 2020-01-07 |
| 1104474808 | Proliance Surgeons, Inc., P.s. | Durable Medical Equipment & Medical Supplies | 1231 116th Ave Ne Ste 755, Bellevue, WA 98004-3804 | 2019-08-27 |
| 1417512021 | Proliance Surgeons, Inc., P.s. | Orthopaedic Surgery | 1620 Lake Tapps Pkwy Se Ste 115, Auburn, WA 98092-8376 | 2019-05-08 |
| 1205307253 | Proliance Surgeons, Inc., P.s. | Orthopaedic Surgery | 901 Boren Ave Ste 711, Seattle, WA 98104-3301 | 2018-12-16 |
| 1972073799 | Proliance Surgeons, Inc., P.s. | Orthopaedic Surgery | 150 Andover Park W, Tukwila, WA 98188-2801 | 2018-12-05 |
| 1184106262 | Proliance Surgeons, Inc., P.s. | Orthopaedic Surgery | 18100 Ne Union Hill Rd Ste 330, Redmond, WA 98052-3330 | 2018-09-05 |
| 1184140477 | Proliance Surgeons, Inc., P.s. | Radiology | 6808 220th St Sw Ste 105, Mountlake Terrace, WA 98043-2187 | 2017-08-17 |
| 1255736971 | Proliance Surgeons, Inc., P.s. | Surgery | 1519 3rd St Se Ste 210, Puyallup, WA 98372-3742 | 2014-10-23 |
| 1467883116 | Proliance Surgeons, Inc., P.s. | Physical Medicine & Rehabilitation | 1017 20th St, Anacortes, WA 98221-2505 | 2013-12-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PROLIANCE SURGEONS, INC., P.S. | 805 Madison St Ste 901, Seattle, WA 98104-1172 |
| Washington State Corporations | PROLIANCE SURGEONS, INC., P.S. | 805 Madison St Ste 901, Seattle, WA 98104-1172 |
| Street Address |
12333 NE 130TH LN SUITE 440 |
| City | KIRKLAND |
| State | WA |
| Zip Code | 98034-7467 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538169768 | Steven Michael Dawson | Specialist | 12333 Ne 130th Ln, Suite 440, Kirkland, WA 98034-7467 | 2005-07-29 |
| 1003364258 | Kirsten Myhres | Genetic Counselor, MS | 12333 Ne 130th Ln, Tan 240, Kirkland, WA 98034-7467 | 2016-09-16 |
| 1043694185 | King County Public Hospital District No. 2 | Clinic/Center | 12333 Ne 130th Ln, #420, Kirkland, WA 98034-7467 | 2015-07-18 |
| 1285028837 | Rebecca Lewis | Physician Assistant | 12333 Ne 130th Ln, Suite 400, Kirkland, WA 98034-7467 | 2015-03-21 |
| 1427440296 | Marlene Woolf | Pharmacist | 12333 Ne 130th Ln, Tan 415, Kirkland, WA 98034-7467 | 2015-03-03 |
| 1588054332 | Evergreenhealthcare | Clinic/Center | 12333 Ne 130th Ln, Tan 415, Kirkland, WA 98034-7467 | 2015-02-02 |
| 1801286810 | Katelin Toshiko Brooks | Pharmacist | 12333 Ne 130th Ln, Tan 415, Kirkland, WA 98034-7467 | 2015-01-28 |
| 1770983108 | Margo Hollenbeck | Pharmacist | 12333 Ne 130th Ln, Kirkland, WA 98034-7467 | 2014-09-04 |
| 1245590637 | Julianna Nadine Walker | Genetic Counselor, MS | 12333 Ne 130th Ln, Suite Tan 240, Kirkland, WA 98034-7467 | 2012-05-21 |
| 1467727198 | Cynthia K Mackenzie | Pharmacist | 12333 Ne 130th Ln, Tan 415, Kirkland, WA 98034-7467 | 2012-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578116596 | Rachel Bowers | Behavior Technician | 1335 Northeast 122nd Way, Suite 105, Kirkland, WA 98034 | 2019-07-18 |
| 1740841048 | Kristina Louise Inghram | Behavior Technician | 11415 Ne 128th St., Suite 40, Kirkland, WA 98034 | 2019-06-26 |
| 1053978064 | Matthew A. Bagnulo, Dds, Ps | Dentist | 11830 Ne 128th St., #202, Kirkland, WA 98034 | 2019-05-24 |
| 1629568928 | Stephanie Michalko | Optometrist | 11800 Ne 128th St Ste 110, Kirkland, WA 98034 | 2018-05-14 |
| 1952800013 | Heath Family Counseling LLC | Marriage & Family Therapist | 12025 115th Ave. Ne, Building D, Ste 200, Kirkland, WA 98034 | 2018-02-05 |
| 1891202834 | Barbara Josephine Gorham | Counselor | 2025 115th Ave Ne, Bldg D, #200, Kirkland, WA 98034 | 2017-12-29 |
| 1548782915 | Eleanor Hollis Wall | Counselor | 14340 102nd Ave Ne, Kirkland, WA 98034 | 2017-07-07 |
| 1457885212 | Peter Schoonmaker | Hospitalist | 12040 Ne 128th Street, Ms105, Kirkland, WA 98034 | 2017-04-18 |
| 1780124370 | Rebecca Managan | Advanced Practice Midwife | 12303 Ne 130th Ln Ste Coral225, Kirkland, WA 98034 | 2017-03-01 |
| 1669821104 | Winter Gonzalez | Counselor | 11720 97th Ln Ne Apt A411, Kirkland, WA 98034 | 2016-06-06 |
| Find all providers in zip 98034 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063429850 | Kenneth D Faw | Otolaryngology | 12333 Ne 130th Ln Ste 440, Kirkland, WA 98034-7467 | 2006-08-02 |
| 1134154131 | John M Brockenbrough | Otolaryngology | 12303 Ne 130th Ln Ste 400, Kirkland, WA 98034-3041 | 2006-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093220980 | Sound E.n.t. Consultants, LLC | Otolaryngology | 406 Yauger Way Sw Ste B, Olympia, WA 98502-8151 | 2017-12-13 |
| 1104203793 | Eric Andrew Eisen | Otolaryngology | 8301 161st Ave Ne Ste 102, Redmond, WA 98052-3858 | 2015-05-03 |
| 1598182990 | Annie Kyunga Ahn | Otolaryngology | 4033 Talbot Rd S Ste 540, Renton, WA 98055 | 2014-03-24 |
| 1760810311 | Gerald Guy Randolph | Otolaryngology | 10491 E State Route 106, Union, WA 98592 | 2013-10-17 |
| 1689007320 | Aria Jafari | Otolaryngology | 1959 Ne Pacific St # 356515, Seattle, WA 98195-3729 | 2013-08-16 |
| 1326306317 | Priyanka Shah O'brien | Otolaryngology | 1801 1st Ave Ste 3a, Longview, WA 98632-3271 | 2012-04-26 |
| 1033486402 | Richard J. Cavell | Otolaryngology | 1013 Marshall Dr, Camano Island, WA 98282-8787 | 2011-11-29 |
| 1457628497 | Robin Lee Downey | Otolaryngology | 4020 Aurora Ave N Apt 410, Seattle, WA 98103-7882 | 2011-11-18 |
| 1588955785 | Nicholas C Vanburen | Otolaryngology | 1424 N Mcdonald Rd Ste 101, Spokane Valley, WA 99216-6017 | 2011-04-22 |
| 1881925956 | Steve Lars Risa | Otolaryngology | 4538 177th Ave Se, Bellevue, WA 98006-6519 | 2010-01-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.