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Organization
AGAVE FOOT SPECIALISTS, PLLC
Active
Organization
AGAVE FOOT SPECIALISTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HEATHER ANN COUCH D.P.M. (OWNER/PODIATRIST)
(623) 322-5501
Entity
Organization
Contact information
Practice address
16841 N. 31ST AVE., STE. 134, PHOENIX, AZ 85053-3051
(623) 322-5501
(623) 322-8996
Mailing address
16841 N. 31ST AVE., STE. 134, PHOENIX, AZ 85053-3051
(623) 322-5501
(623) 322-8996
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0552
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD0997
RAILROAD MEDICARE
AZ
01
—
Z78990
MEDICARE ID-PIN
AZ
Enumeration date
08/22/2006
Last updated
02/26/2008
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