Meadow Creek Healthcare LLC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

423 Issued in AK

Legal business name

MEADOW CREEK HEALTHCARE LLC

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

Organization subpart

No

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.

Title

Owner

Phone

(907) 694-3303

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Meadow Creek Dermatology Doing business as

Locations

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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MPG0123",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadow Creek Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Candice Christina McKinnon, C.N.A
• Heather Ann McLain, DPT
• Sam McMichael
• Ashlyn McVey
• Tracie Meaders, LPC
• Meadowcreek Healthcare
• Meaningful Living LLC
• Audrey Means
• Medical Network of Alaska, LLC
• Tanner Menard

• Medical Physician Assistant in Eagle River, AK
• Providers in Eagle River, AK by specialty
• Medical Physician Assistant in Alaska

• 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.