NPIMap

Organization Active NPI

Meadow Creek Healthcare LLC

Doing business as Meadow Creek Dermatology

  • Medical Physician Assistant
  • Eagle River, AK
National Provider Identifier
1376835355
Registry record updated May 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
423 Issued in AK
Legal business name
MEADOW CREEK HEALTHCARE LLC
Doing business as
Meadow Creek Dermatology
Practice address
16839 Park Place St
Same
Eagle River, AK 99577-7819
Phone
(907) 694-3303
Fax
(907) 694-4773
NPI assigned
May 9, 2011
Last updated
May 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2011

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

Authorized official

Name
Thomas A Fenger, PH.D, P.A.NPI 1699767418
Title
Owner
Phone
(907) 694-3303

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AM0700X 423 AK Primary

Addresses

Primary practice location

16839 Park Place St
Same
Eagle River, AK 99577-7819

Mailing address

16839 Park Place St
Same
Eagle River, AK 99577-7819
Phone (907) 694-3303

Other names 1

  • Meadow Creek Dermatology Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1304899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304899200000",
    "number": "1376835355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16839 PARK PLACE ST",
            "address_2": "SAME",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777819",
            "telephone_number": "907-694-3303",
            "fax_number": "907-694-4773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16839 PARK PLACE ST",
            "address_2": "SAME",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777819",
            "telephone_number": "907-694-3303",
            "fax_number": "907-694-4773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOW CREEK HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-09",
        "last_updated": "2011-05-09",
        "status": "A",
        "authorized_official_last_name": "FENGER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-694-3303",
        "authorized_official_credential": "PH.D, P.A."
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "AK",
            "license": "423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadow Creek Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagle River, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.