Provider Demographics
NPI:1982775904
Name:J & G MIKES ENTERPRISES INC
Entity Type:Organization
Organization Name:J & G MIKES ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:MIKES
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD LD
Authorized Official - Phone:405-659-2805
Mailing Address - Street 1:8512 TIFFANY DRIVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132
Mailing Address - Country:US
Mailing Address - Phone:405-659-2805
Mailing Address - Fax:405-728-2402
Practice Address - Street 1:8512 TIFFANY DRIVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132
Practice Address - Country:US
Practice Address - Phone:405-659-2805
Practice Address - Fax:405-728-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1107133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200072920 AMedicaid
OK200072920 AMedicaid