Healthcare Provider Details

I. General information

NPI: 1285295089
Provider Name (Legal Business Name): MODERN SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 E RIGGS RD STE 104
SUN LAKES AZ
85248-7759
US

IV. Provider business mailing address

10450 E RIGGS RD STE 104
SUN LAKES AZ
85248-7759
US

V. Phone/Fax

Practice location:
  • Phone: 502-415-2836
  • Fax:
Mailing address:
  • Phone: 502-415-2836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA ADAMS
Title or Position: OWNER
Credential:
Phone: 480-306-6627