1649603739 NPI number — MGA HEALTHCARE TEXAS, INC

Table of content: (NPI 1649603739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649603739 NPI number — MGA HEALTHCARE TEXAS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MGA HEALTHCARE TEXAS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649603739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 E CAMELBACK RD
Provider Second Line Business Mailing Address:
STE. 200
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85016-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-508-1883
Provider Business Mailing Address Fax Number:
602-385-4941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15601 DALLAS PKWY
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
ADDISON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75001-3353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-292-9900
Provider Business Practice Location Address Fax Number:
214-292-9809
Provider Enumeration Date:
08/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
OCHOA
Authorized Official First Name:
ARIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
602-508-1883

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  016220 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 342712201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com