Provider Demographics
NPI:1033162862
Name:TAKL CORPORATION
Entity Type:Organization
Organization Name:TAKL CORPORATION
Other - Org Name:MED PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:KOONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-986-7747
Mailing Address - Street 1:24980 STATE ST
Mailing Address - Street 2:STE 4
Mailing Address - City:ELBERTA
Mailing Address - State:AL
Mailing Address - Zip Code:36530-2573
Mailing Address - Country:US
Mailing Address - Phone:251-986-7747
Mailing Address - Fax:251-986-7748
Practice Address - Street 1:24980 STATE ST
Practice Address - Street 2:STE 4
Practice Address - City:ELBERTA
Practice Address - State:AL
Practice Address - Zip Code:36530-2573
Practice Address - Country:US
Practice Address - Phone:251-986-7747
Practice Address - Fax:251-986-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009964545Medicaid
AL009964545Medicaid