MEDICARE: TKG INC.

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	251E00000X	Home Health Agency	7723	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407859606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TKG INC.

Provider Business Mailing Address
First Line	:	3854 AMERICAN WAY STE A
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4897
Country	:	US
Telephone Number	:	225-292-2031
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 N WASHINGTON AVE
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-3403
Country	:	US
Telephone Number	:	580-317-8079
Fax Number	:	580-317-9275

Authorized Official
Title or Position	:	SVP TAX
Name	:	TRAVIS MIGLICCO
Credential	:
Telephone Number	:	225-299-3803

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/19/2024

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Directions to “TKG INC. ” Practice Location

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