MEADOW CREEK HEALTHCARE LLC NPI 1376835355

NPI Information

NPI: 1376835355
Provider Name: MEADOW CREEK HEALTHCARE LLC

Doing Business As: MEADOW CREEK DERMATOLOGY

Classification: Physician Assistant - 363AM0700X
Entity Type: Organization

Specialization: Medical

Address:
16839 PARK PLACE ST
SAME
EAGLE RIVER, AK
ZIP 99577
Phone: (907) 694-3303
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MEADOW CREEK HEALTHCARE LLC is a medical physician assistant in Eagle River, AK. MEADOW CREEK HEALTHCARE LLC NPI is 1376835355. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Meadow Creek Dermatology.

The provider's business location address is:

16839 PARK PLACE ST
SAME
EAGLE RIVER, AK
ZIP 99577-819
Phone: (907) 694-3303
Fax: (907) 694-4773

The provider's authorized official is Thomas A Fenger .
The authorized official title is Owner and has the following contact phone number (907) 694-3303.

The enumeration date for this NPI number is 5/9/2011 and was last updated on 5/9/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	423	ALASKA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	MPG0123	MEDICAID	ALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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