| Agave Family Medicine & Breast Feeding Support Center Llc | |
|
1925 W Orange Grove Rd Ste 201 Tucson AZ 85704-1151 | |
| (520) 372-2167 | |
| Not Available |
| Full Name | Agave Family Medicine & Breast Feeding Support Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1925 W Orange Grove Rd Ste 201, Tucson, Arizona |
| Authorized Official Name and Position | Mary C Harrel (DIRECTOR) |
| Authorized Official Contact | 6029994659 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Agave Family Medicine & Breast Feeding Support Center Llc 1925 W Orange Grove Rd Ste 201 Tucson AZ 85704-1151 Ph: (520) 372-2167 | Agave Family Medicine & Breast Feeding Support Center Llc 1925 W Orange Grove Rd Ste 201 Tucson AZ 85704-1151 Ph: (520) 372-2167 |
| NPI Number | 1265165484 |
|---|---|
| Provider Enumeration Date | 07/06/2022 |
| Last Update Date | 09/30/2022 |
| Medicare PECOS PAC ID | 4183091580 |
|---|---|
| Medicare Enrollment ID | O20221027000970 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265165484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mary C Harrel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487882049 PECOS PAC ID: 5092933044 Enrollment ID: I20140904001132 |
| Provider Name | Kiely Elizabeth Lavery |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1073237079 PECOS PAC ID: 3870835283 Enrollment ID: I20221223001064 |
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