50D1010072 CLIA NUMBER - PROLIANCE EASTSIDE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 50D1010072
  • Facility Name: PROLIANCE EASTSIDE SURGERY CENTER
  • Facility Address: 12911 120TH AVE NE STE H110
    KIRKLAND, WA
    ZIP 98034
  • Facility Phone: 425 216-7000
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: TIANA DORSEY
  • NPI Number: 1790724862
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D1010072
LAB Type Ambulatory Surgery Center
Facility Name PROLIANCE EASTSIDE SURGERY CENTER
Street 12911 120TH AVE NE STE H110
City KIRKLAND
State WA
ZIP 98034
Phone 425 216-7000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2003
Certificate Expiration Date 4/4/2028
Facility Type Ambulatory Surgery Center
Lab Director TIANA DORSEY

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This page was last updated on: 3/20/2025