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General NPI Number Information
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NPI Number | 1407859606
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Entity Type | Organization
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Legal Business Name | TKG INC.
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 523 N WASHINGTON AVE
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City | DURANT
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State | OK
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Zip | 74701-3403
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Country | US
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Telephone | 580-317-8079
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Fax | 580-317-9275
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Provider Business Mailing Address
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Address Line | 3854 AMERICAN WAY STE A
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City | BATON ROUGE
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State | LA
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Zip | 70816-4897
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Country | US
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Telephone | 225-292-2031
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Fax |
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Authorized Official
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Title or Position | SVP TAX
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Name | TRAVIS MIGLICCO
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Credential |
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Telephone | 225-299-3803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 7723
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License Number State | OK
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