Provider Demographics
NPI:1376836551
Name:TUCK ENTERPRISES LLC
Entity Type:Organization
Organization Name:TUCK ENTERPRISES LLC
Other - Org Name:AMERICAN DIABETES SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-430-1456
Mailing Address - Street 1:8361 CHADBURN WAY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-7277
Mailing Address - Country:US
Mailing Address - Phone:334-430-1456
Mailing Address - Fax:334-396-9882
Practice Address - Street 1:8361 CHADBURN WAY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-7277
Practice Address - Country:US
Practice Address - Phone:334-430-1456
Practice Address - Fax:334-396-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-22
Last Update Date:2011-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0003885332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies