Provider Demographics
NPI:1407902372
Name:MARY BRIDGE CHILDRENS HEALTH ALLIANCE
Entity Type:Organization
Organization Name:MARY BRIDGE CHILDRENS HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUPPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-830-3221
Mailing Address - Street 1:PO BOX 5888
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0888
Mailing Address - Country:US
Mailing Address - Phone:253-830-3297
Mailing Address - Fax:253-830-3296
Practice Address - Street 1:2106 PACIFIC AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3007
Practice Address - Country:US
Practice Address - Phone:253-830-3297
Practice Address - Fax:253-830-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty