Provider Demographics
NPI:1568485761
Name:TIROG AT VALLEY PLLC
Entity Type:Organization
Organization Name:TIROG AT VALLEY PLLC
Other - Org Name:SEATTLE PROISTATE BRACHYTHERAPY PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-386-2323
Mailing Address - Street 1:1221 MADISON STREET
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3589
Mailing Address - Country:US
Mailing Address - Phone:206-215-6251
Mailing Address - Fax:206-215-6345
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-251-5121
Practice Address - Fax:425-656-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I3540OtherRR MEDICARE
WA7090822Medicaid
I3540OtherRR MEDICARE