Provider Demographics
NPI:1063188977
Name:MGA HEALTHCARE TEXAS, LLC
Entity type:Organization
Organization Name:MGA HEALTHCARE TEXAS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KOLOSKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-751-1278
Mailing Address - Street 1:7025 N SCOTTSDALE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3675
Mailing Address - Country:US
Mailing Address - Phone:602-385-8733
Mailing Address - Fax:602-385-4930
Practice Address - Street 1:7550 W IH 10 STE 780
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5803
Practice Address - Country:US
Practice Address - Phone:210-200-8928
Practice Address - Fax:210-579-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health