Provider Demographics
NPI:1699775668
Name:PIKE MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:PIKE MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ONIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-754-5555
Mailing Address - Street 1:905 BUSINESS HWY 161 S
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-0000
Mailing Address - Country:US
Mailing Address - Phone:573-324-2241
Mailing Address - Fax:573-324-5137
Practice Address - Street 1:905 BUSINESS HWY 161 S
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-0000
Practice Address - Country:US
Practice Address - Phone:573-324-2241
Practice Address - Fax:573-324-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5C36207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty