Provider Demographics
NPI:1518157320
Name:ALPHA ADVANTAGE
Entity Type:Organization
Organization Name:ALPHA ADVANTAGE
Other - Org Name:MARWILSON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JERETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-284-3255
Mailing Address - Street 1:1119 PACIFIC AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4374
Mailing Address - Country:US
Mailing Address - Phone:253-284-3262
Mailing Address - Fax:253-627-8783
Practice Address - Street 1:1119 PACIFIC AVE FL 5
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4374
Practice Address - Country:US
Practice Address - Phone:253-284-3262
Practice Address - Fax:253-627-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies