=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427245547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEADOW CREEK FAMILY MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2007
-----------------------------------------------------
Last Update Date | 10/02/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22510 SE 64TH PL STE 130
-----------------------------------------------------
City | ISSAQUAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98027-5389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-427-8750
-----------------------------------------------------
Fax | 425-427-8755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22510 SE 64TH PL STE 130
-----------------------------------------------------
City | ISSAQUAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98027-5389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-427-8750
-----------------------------------------------------
Fax | 425-427-8755
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SIGRID BARNICKEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 425-427-8750
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 173000000X
-----------------------------------------------------
Taxonomy Name | Legal Medicine
-----------------------------------------------------
License Number | MD00024160
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------