Agave Family Medicine & Breast Feeding Support Center LLC
Organization Active NPI Family Medicine Physician · Tucson, AZ
NPI 1265165484 · NPPES record last updated Sep 30, 2022
Key facts
- NPI
- 1265165484
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AGAVE FAMILY MEDICINE & BREAST FEEDING SUPPORT CENTER LLC
- Practice address
- 1925 W Orange Grove Rd Ste 201
Tucson, AZ 85704-1151 - Phone
- (520) 372-2167
- NPI assigned
- Jul 6, 2022
- Organization subpart
- No
Authorized official
- Name
- Dr. Mary C Harrel, MD
- Title
- Director
- Phone
- (602) 999-4659
Practitioners 3
-
Sameer Suhale, MD
-
Dan Carter, FNPC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2222292 | Agave Family Medicine | Provider-performed microscopy | Apr 27, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221027000970 | AZ | Part B Supplier - Clinic/Group Practice | 4183091580 |
Receives reassigned benefits from 2 practitioners Practice locations: Tucson, AZ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1925 W Orange Grove Rd Ste 201
Tucson, AZ 85704-1151
Mailing address
1925 W Orange Grove Rd Ste 201
Tucson, AZ 85704-1151
Phone (520) 372-2167
Other providers in Tucson, AZ
- Sam Afshar
- Agape Hospice & Palliative Care, LLC
- Agape Palliative Care, LLC
- Deepa Agarwal
- Agave Family Medicine
- Agave Mental Wellness Institute
- Agave Surgical Associates PC
- Amanda Maryam Agbannawag
- Agc Plus
- Jordan Agee
All providers in Tucson, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.