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General NPI Number Information
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NPI Number | 1740280767
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Entity Type | Organization
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Legal Business Name | PIKE MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 08/01/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 211 S 3RD ST
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City | LOUISIANA
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State | MO
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Zip | 63353-2000
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Country | US
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Telephone | 573-754-5555
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Fax | 573-754-4077
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Provider Business Mailing Address
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Address Line | 211 S 3RD ST
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City | LOUISIANA
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State | MO
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Zip | 63353-2000
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Country | US
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Telephone | 573-754-5555
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Fax | 573-754-4077
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JAN F ONIK
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Credential | DO
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Telephone | 573-754-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R5C36
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License Number State | MO
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