MEDICARE: MR. JOHN TAMBE AYAMBA MASTER'S IN THEOLOGY

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	171M00000X	Case Manager/Care Coordinator	CM11	OK

General Provider Information

NPI Number	:	1700328259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN TAMBE AYAMBA MASTER'S IN THEOLOGY

Provider Business Mailing Address
First Line	:	2712 N MERIDIAN AVE
Second Line	:	APT 253
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-1067
Country	:	US
Telephone Number	:	202-802-5997
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 NW 23RD ST
Second Line	:	SUITE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-2367
Country	:	US
Telephone Number	:	202-802-5997
Fax Number	:

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

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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