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General NPI Number Information
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NPI Number | 1699135483
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Entity Type | Organization
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Legal Business Name | MODERN HEALTHCARE, INC
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 07/05/2019
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Provider Practice Location Address
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Address Line | 3201 W PEORIA AVE STE A105
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City | PHOENIX
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State | AZ
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Zip | 85029-4609
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Country | US
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Telephone | 602-699-6353
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Fax | 602-699-6354
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Provider Business Mailing Address
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Address Line | 2942 N 24TH ST STE 114
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City | PHOENIX
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State | AZ
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Zip | 85016-7849
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Country | US
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Telephone | 602-699-6353
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Fax | 602-699-6354
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW MICHAEL RHODES
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Credential | NP
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Telephone | 602-699-6353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 41767
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 7417
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | RN198428
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP8585
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License Number State | AZ
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