50D2036112 CLIA NUMBER - PROLIANCE CENTER FOR SPECIALTY SURGERY

Laboratory Demographics

  • CLIA Code: 50D2036112
  • Facility Name: PROLIANCE CENTER FOR SPECIALTY SURGERY
  • Facility Address: 515 MINOR AVE STE 130
    SEATTLE, WA
    ZIP 98104
  • Facility Phone: 206 838-9500
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DOUGLAS BACKOUS
  • NPI Number: 1326094491
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D2036112
LAB Type Ambulatory Surgery Center
Facility Name PROLIANCE CENTER FOR SPECIALTY SURGERY
Street 515 MINOR AVE STE 130
City SEATTLE
State WA
ZIP 98104
Phone 206 838-9500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2012
Certificate Expiration Date 4/4/2028
Facility Type Ambulatory Surgery Center
Lab Director DOUGLAS BACKOUS

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