Healthcare Provider Details

I. General information

NPI: 1639093149
Provider Name (Legal Business Name): MGA HEALTHCARE ARKANSAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3291 S THOMPSON ST STE E104
SPRINGDALE AR
72764-7096
US

IV. Provider business mailing address

7025 N SCOTTSDALE RD STE 200
SCOTTSDALE AZ
85253-3675
US

V. Phone/Fax

Practice location:
  • Phone: 479-304-6534
  • Fax: 479-546-2275
Mailing address:
  • Phone: 479-304-6534
  • Fax: 479-546-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA KOLOSKUS
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 720-276-7706