NPIMap

Organization Active NPI

Alpha Advantage Mco

  • Customized Equipment (DME)
  • Lakewood, WA
National Provider Identifier
1841568953
Registry record updated Dec 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
License
602187014 Issued in WA
Legal business name
ALPHA ADVANTAGE MCO
Practice address
6108 Community PL SW
Lakewood, WA 98499-2447
Phone
(253) 468-7914
NPI assigned
Dec 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Jeretha Marbury
Title
Ceo
Phone
(253) 468-7914

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Local Education Agency (LEA) 251300000X 602187014 WA
Supports Brokerage Agency 251X00000X 602187014 WA
Health Maintenance Organization 302R00000X 602187014 WA
Customized Equipment (DME) 332BC3200X 602187014 WA Primary
Transportation Broker 347E00000X 602187014 WA

Addresses

Primary practice location

6108 Community PL SW
Lakewood, WA 98499-2447

Mailing address

PO Box 112243
Tacoma, WA 98411-2243

Other identifiers 1

IdentifierTypeStateIssuer
146954MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Alpha Advantage2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6108 Community Pl SW
Lakewood, WA 98499
Phone (253) 468-7914

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322784000000",
    "number": "1841568953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 112243",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984112243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6108 COMMUNITY PL SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992447",
            "telephone_number": "253-468-7914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPHA ADVANTAGE MCO",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-02",
        "last_updated": "2011-12-02",
        "status": "A",
        "authorized_official_last_name": "MARBURY",
        "authorized_official_first_name": "JERETHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "253-468-7914",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": "WA",
            "license": "602187014",
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "WA",
            "license": "602187014",
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "WA",
            "license": "602187014",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "WA",
            "license": "602187014",
            "primary": true
        },
        {
            "code": "347E00000X",
            "taxonomy_group": "",
            "desc": "Transportation Broker",
            "state": "WA",
            "license": "602187014",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146954",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.