1568485761 NPI number — TIROG AT VALLEY PLLC

Table of content: (NPI 1275591778)

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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