MODERN SPORTS MEDICINE LLC (NPI# 1700495892) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700495892 |
| Entity Type | Organization |
| Organization Name | MODERN SPORTS MEDICINE LLC |
| Practice Address |
14821 N Del Webb Blvd Sun City AZ 85351-2145 |
| Mailing Address |
1840 E Warner Rd Ste 121 Tempe AZ 85284-3445 |
| Practice Telephone | 4808784806 |
| Practice Fax Number | 4808401672 |
| Mailing Telephone | 4808784806 |
| Mailing Fax Number | 4808401672 |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2020-07-24 |
| Authorized Official Name | MRS. HALEIGH MERSHON (DIRECTOR OF REVENUE) |
| Authorized Official Telephone | 4808784806 |
| Is Organization Subpart | Y |
| Parent Organization Name | MODERN SPORTS MEDICINE LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2083S0010X |
Preventive Medicine Specialization: Sports Medicine |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568072387 | Modern Sports Medicine LLC | Physical Therapist | 1840 E Warner Rd Ste 121, Tempe, AZ 85284-3445 | 2020-08-06 |
| 1942810833 | Modern Sports Medicine LLC | Specialist | 6242 E Arbor Ave Unit 1, Mesa, AZ 85206-1309 | 2020-08-05 |
| 1285295089 | Modern Sports Medicine LLC | Family Medicine | 10450 E Riggs Rd Ste 104, Sun Lakes, AZ 85248-7759 | 2019-06-24 |
| Street Address |
14821 N DEL WEBB BLVD |
| City | SUN CITY |
| State | AZ |
| Zip Code | 85351-2145 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104968288 | Medsource Orthotics & Prosthetics | Prosthetic/Orthotic Supplier | 14821 N Del Webb Blvd, Suite 24, Sun City, AZ 85351 | 2007-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467003566 | T&h Hearing LLC | Hearing Aid Equipment | 13616 N. 99th Ave., Sun City, AZ 85351 | 2019-09-20 |
| 1881247682 | Amanda M Neri | Physician Assistant | 10401 W. Thunderbird Blvd Md Anderson - Banner Boswell, Sun City, AZ 85351 | 2019-07-20 |
| 1649822313 | Azmed Rehab LLC | Family Medicine | 14281 North Del Webb Blvd, Sun City, AZ 85351 | 2019-07-12 |
| 1982182267 | Akdhc, LLC | Internal Medicine | 10249 W Thunderbird Blvd Ste 100, Sun City, AZ 85351 | 2018-07-30 |
| 1871084814 | Amy Mikulec | Physical Therapist | Banner Physical Therapy and Rehab Boswell, 10503 W Thunderbird Blvd Suite 263a, Sun City, AZ 85351 | 2018-05-25 |
| 1194238345 | Lorie Jo Matthews | Nurse Practitioner | 10494 W Thunderbird Blvd Ste 102, Sun City, AZ 85351 | 2017-11-09 |
| 1184153363 | Susan Jane Hockman | Registered Nurse | 14601 N Delwebb Blvd, Sun City, AZ 85351 | 2017-06-09 |
| 1043769169 | Medsource Orthotics & Prosthetics, Inc | Prosthetic/Orthotic Supplier | 13203 N 103rd Ave Ste J1&j2, Sun City, AZ 85351 | 2016-09-30 |
| 1033563002 | Vittoria Giovannucci | Technician/Technologist | 10503 W Thunderbird Blvd Ste 101a, Sun City, AZ 85351 | 2016-04-15 |
| 1669858379 | Qui Nguyen | Pharmacist | 10660 Nw Grand Ave, Sun City, AZ 85351 | 2015-08-04 |
| Find all providers in zip 85351 | ||||
| Taxonomy Code | 2083S0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Sports Medicine |
| A preventive medicine physician who specializes in the diagnosis and treatment of sports related conditions and injuries. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720507262 | At Direct Sports Medicine, LLC | Preventive Medicine | 6424 E Fairfield St, Mesa, AZ 85205-6042 | 2017-09-15 |
| 1528488434 | Cassandra Erickson | Preventive Medicine | 222 W Thomas Rd, Phoenix, AZ 85013-4419 | 2014-04-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.