Healthcare Provider Details

I. General information

NPI: 1497711311
Provider Name (Legal Business Name): MEREDITH A HEICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S MCCLELLAN ST SUITE 200
SPOKANE WA
99204-2457
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-1144
  • Fax: 509-455-4166
Mailing address:
  • Phone: 866-747-2455
  • Fax: 509-944-9644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00019101
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD00019101
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: