1851039978 NPI number — MGA HOME HEALTHCARE TENNESSEE, LLC

Table of content: DR. KATHRYN ELLIOTT NAGEL MD (NPI 1881124626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851039978 NPI number — MGA HOME HEALTHCARE TENNESSEE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MGA HOME HEALTHCARE TENNESSEE, LLC
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:
1851039978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7025 N SCOTTSDALE RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85253-3675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1661 INTERNATIONAL DR STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-221-2266
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2022

Additional Information

Authorized Official

Authorized Official Last Name:
KOLOSKUS
Authorized Official First Name:
ALEXANDRA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
720-276-7706

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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