50D1042854 CLIA NUMBER - PROLIANCE HILLSIDE MEDICAL SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 50D1042854
  • Facility Name: PROLIANCE HILLSIDE MEDICAL SURGERY CENTER
  • Facility Address: 104 27TH AVE SE
    PUYALLUP, WA
    ZIP 98374
  • Facility Phone: 253 770-9000
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: VONNIE PRESCOTT
  • NPI Number: 1780610220
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D1042854
LAB Type Ambulatory Surgery Center
Facility Name PROLIANCE HILLSIDE MEDICAL SURGERY CENTER
Street 104 27TH AVE SE
City PUYALLUP
State WA
ZIP 98374
Phone 253 770-9000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2005
Certificate Expiration Date 4/4/2028
Facility Type Ambulatory Surgery Center
Lab Director VONNIE PRESCOTT

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This page was last updated on: 9/29/2025