MEDICARE: MR. VINCENT C. DIKE

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	172V00000X	Community Health Worker
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1366754228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VINCENT C. DIKE

Provider Business Mailing Address
First Line	:	1109 RICHMOND RD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-3232
Country	:	US
Telephone Number	:	405-370-8183
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 SE 22ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73129-8413
Country	:	US
Telephone Number	:	405-370-8183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	07/08/2010

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Directions to “ MR. VINCENT C. DIKE ” Practice Location

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