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  7. NPI Record 1548832017

PROLIANCE SURGEONS, INC., P.S.
Complete NPI Record 1548832017
Clinic/Center - Magnetic Resonance Imaging (MRI) in Puyallup, WA

NPI Status: Active since July 14, 2021

Contact Information

3801 5TH ST SE
SUITE 120
PUYALLUP, WA
ZIP 98374
Phone: (253) 864-4106
Fax: (253) 864-4143

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Second Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Title or Position
  24. Authorized Official Telephone Number
  25. Healthcare Provider Taxonomy Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Healthcare Provider Taxonomy Code 2
  28. Healthcare Provider Primary Taxonomy Switch 2
  29. Healthcare Provider Taxonomy Code 3
  30. Healthcare Provider Primary Taxonomy Switch 3
  31. Healthcare Provider Taxonomy Code 4
  32. Healthcare Provider Primary Taxonomy Switch 4
  33. Healthcare Provider Taxonomy Code 5
  34. Healthcare Provider Primary Taxonomy Switch 5
  35. Is Organization Subpart
  36. Authorized Official Name Prefix Text
  37. Healthcare Provider Taxonomy Group 1
  38. Healthcare Provider Taxonomy Group 2
  39. Healthcare Provider Taxonomy Group 3
  40. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1548832017. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1548832017
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 3801 5TH ST SE STE 110
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: PUYALLUP
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address State Name: WA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 983742106
The city name in the location address of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 2538459585
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 3801 5TH ST SE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE 120
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: PUYALLUP
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: WA
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Practice Location Address Postal Code: 983742103
The fax number associated with the location address of the provider being identified.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 2538644106
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 2538644143
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 7/14/2021
The State code in the location of the provider being identified.
Last Update Date: 7/14/2021
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Authorized Official Last Name: KLEISLE
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Authorized Official First Name: LAURA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Authorized Official Title or Position: CHIEF RISK OFFICER
The title or position of the authorized official.
Authorized Official Telephone Number: 2068382590
The date the provider was assigned a unique identifier (assigned an NPI).
Healthcare Provider Taxonomy Code 1: 2085R0202X
The date that a record was last updated or changed.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 2085R0204X
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 2471M1202X
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 261QM1200X
Healthcare Provider Primary Taxonomy Switch 4: Y
Healthcare Provider Taxonomy Code 5: 261QR0200X
Healthcare Provider Primary Taxonomy Switch 5: N
Is Organization Subpart: N
Authorized Official Name Prefix Text: MRS.
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 6/17/2021