Healthcare Provider Details

I. General information

NPI: 1861153579
Provider Name (Legal Business Name): AGAVE ADULT MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 BELL ROCK PLZ STE C
SEDONA AZ
86351-9066
US

IV. Provider business mailing address

70 BELL ROCK PLZ STE C
SEDONA AZ
86351-9066
US

V. Phone/Fax

Practice location:
  • Phone: 315-717-7898
  • Fax:
Mailing address:
  • Phone: 928-284-2658
  • Fax: 928-284-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DREW STURGIS
Title or Position: OWNER
Credential:
Phone: 661-644-1259