Provider Demographics
NPI:1700495892
Name:MODERN SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:MODERN SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-306-6627
Mailing Address - Street 1:1840 E WARNER RD STE 121
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3445
Mailing Address - Country:US
Mailing Address - Phone:480-878-4806
Mailing Address - Fax:480-840-1672
Practice Address - Street 1:14821 N DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2145
Practice Address - Country:US
Practice Address - Phone:480-878-4806
Practice Address - Fax:480-840-1672
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MODERN SPORTS MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-24
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports MedicineGroup - Multi-Specialty