Proliance Surgeons INC P S
Orthopaedic Surgery in Issaquah, WA. Organization (NPI-2).
NPI number1124500293
StatusActive
Last updated in NPPESOct 30, 2025
Details
- NPI
- 1124500293
- Entity type
- Organization (NPI-2)
- Legal business name
- Proliance Surgeons INC P S
- Organization subpart
- No
- Enumeration date
- Sep 5, 2018
- Certification date
- Oct 30, 2025
- Last updated
- Oct 30, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · DME SUPPLIER - PHYSICIAN - ORTHOPEDIC/ORTHOPEDIC SURGERY
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207X00000X | Orthopaedic Surgery | 601484763 | WA | Yes |
| 363AS0400X | Physician Assistant, Surgical | 601484763 | WA | |
| 208100000X | Physical Medicine & Rehabilitation | 601484763 | WA |
Other names
- Proliance Orthopaedics And Sports Medicine (Doing Business As)
Practice location
510 8th Ave Ne Ste 200Issaquah, WA 98029-5436
Phone 425-392-3030 · Fax 425-392-2564
Mailing address
510 8th Ave Ne Ste 320Issaquah, WA 98029-5436
Phone 425-507-0733 · Fax 425-283-5551
Authorized official
Kenneth G. Overbey
Coo
2068382583
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Orthopaedic Surgery Physician providers in Issaquah, WA
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All 5 Orthopaedic Surgery Physician providers in Issaquah · All 2,127 providers in Issaquah
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