MEDICARE: NATIONAL PIKE HEALTH CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1184481095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL PIKE HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	10400 VINEYARD BLVD STE G100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-3800
Country	:	US
Telephone Number	:	410-744-8100
Fax Number	:	410-744-2530

Provider Business Practice Location Address
First Line	:	10400 VINEYARD BLVD STE G100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-3800
Country	:	US
Telephone Number	:	410-744-8100
Fax Number	:	410-744-2530

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHNSON OWOYEMI
Credential	:	M. SC.
Telephone Number	:	410-375-1456

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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