Provider Demographics
NPI:1992350813
Name:AGILE HEALTHCARE, LLC
Entity type:Organization
Organization Name:AGILE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MHD KUSSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMKARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-741-5504
Mailing Address - Street 1:6036 N 19TH AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2143
Mailing Address - Country:US
Mailing Address - Phone:623-738-0193
Mailing Address - Fax:
Practice Address - Street 1:6036 N 19TH AVE STE 502
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2143
Practice Address - Country:US
Practice Address - Phone:623-738-0193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty