Provider Demographics
NPI:1053342717
Name:AGK SOUTHWEST, INC.
Entity type:Organization
Organization Name:AGK SOUTHWEST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:KORPITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-443-0111
Mailing Address - Street 1:8125 N 23RD AVE
Mailing Address - Street 2:SUITE 221
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4909
Mailing Address - Country:US
Mailing Address - Phone:602-443-0111
Mailing Address - Fax:602-443-0110
Practice Address - Street 1:5055 E BROADWAY BLVD
Practice Address - Street 2:SUITE D-104
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3640
Practice Address - Country:US
Practice Address - Phone:520-747-1800
Practice Address - Fax:520-747-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA 018251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ596223Medicaid
AZ596223Medicaid