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General NPI Number Information
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NPI Number | 1407902372
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Entity Type | Organization
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Legal Business Name | MARY BRIDGE CHILDRENS HEALTH ALLIANCE
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2106 PACIFIC AVE SUITE 600
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City | TACOMA
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State | WA
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Zip | 98402-3007
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Country | US
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Telephone | 253-830-3297
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Fax | 253-830-3296
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Provider Business Mailing Address
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Address Line | PO BOX 5888
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City | TACOMA
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State | WA
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Zip | 98415-0888
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Country | US
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Telephone | 253-830-3297
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Fax | 253-830-3296
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL HUPPE
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Credential |
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Telephone | 253-830-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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