1568485761 NPI number — TIROG AT VALLEY PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568485761 NPI number — TIROG AT VALLEY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIROG AT VALLEY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SEATTLE PROISTATE BRACHYTHERAPY PLLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568485761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 MADISON STREET
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98104-3589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-215-6251
Provider Business Mailing Address Fax Number:
206-215-6345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S 43RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98055-5714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-251-5121
Provider Business Practice Location Address Fax Number:
425-656-4072
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARNETT
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
206-386-2323

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: I3540 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7090822 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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