# AGAVE FOOT SPECIALISTS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861508541
- **Authorized official:** DR. HEATHER ANN COUCH D.P.M. (OWNER/PODIATRIST)
- **Authorized official phone:** (623) 322-5501

## Contact information

- **Practice address:** 16841 N. 31ST AVE., STE. 134, PHOENIX, AZ 85053-3051
- **Practice address phone:** (623) 322-5501
- **Practice address fax:** (623) 322-8996
- **Mailing address:** 16841 N. 31ST AVE., STE. 134, PHOENIX, AZ 85053-3051
- **Mailing address phone:** (623) 322-5501
- **Mailing address fax:** (623) 322-8996

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 0552 | AZ | Yes |

## Other

- **Enumeration date:** 08/22/2006
- **Last updated:** 02/26/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | DD0997 | RAILROAD MEDICARE | AZ |
| 01 | — | Z78990 | MEDICARE ID-PIN | AZ |