Provider Demographics
NPI:1427245547
Name:MEADOW CREEK FAMILY MEDICINE
Entity type:Organization
Organization Name:MEADOW CREEK FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-427-8750
Mailing Address - Street 1:22510 SE 64TH PL STE 130
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5389
Mailing Address - Country:US
Mailing Address - Phone:425-427-8750
Mailing Address - Fax:425-427-8755
Practice Address - Street 1:22510 SE 64TH PL STE 130
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5389
Practice Address - Country:US
Practice Address - Phone:425-427-8750
Practice Address - Fax:425-427-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024160173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF03262Medicare UPIN