Provider Demographics
NPI:1679779177
Name:PIKE INTERNAL MEDICINE
Entity type:Organization
Organization Name:PIKE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DICHIARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-566-1270
Mailing Address - Street 1:1350 HWY 231 SO
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081
Mailing Address - Country:US
Mailing Address - Phone:334-566-1270
Mailing Address - Fax:334-566-1296
Practice Address - Street 1:664 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:BRUNDIDGE
Practice Address - State:AL
Practice Address - Zip Code:36010
Practice Address - Country:US
Practice Address - Phone:334-566-1270
Practice Address - Fax:334-566-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00006320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL52880960Medicaid
ALK491Medicare PIN