Provider Demographics
NPI:1760717813
Name:MEADOWCREEK HEALTHCARE
Entity Type:Organization
Organization Name:MEADOWCREEK HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:FENGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PA
Authorized Official - Phone:907-694-3303
Mailing Address - Street 1:16839 PARK PLACE ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7819
Mailing Address - Country:US
Mailing Address - Phone:907-694-3303
Mailing Address - Fax:907-694-4773
Practice Address - Street 1:16839 PARK PLACE ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7819
Practice Address - Country:US
Practice Address - Phone:907-694-3303
Practice Address - Fax:907-694-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK423261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center