MEDICARE: MODERN SPORTS MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1952270357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN SPORTS MEDICINE LLC

Provider Business Mailing Address
First Line	:	5590 W CHANDLER BLVD STE 4
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-3744
Country	:	US
Telephone Number	:	480-306-6627
Fax Number	:	480-306-6696

Provider Business Practice Location Address
First Line	:	6910 E CHAUNCEY LN STE 115
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-5161
Country	:	US
Telephone Number	:	480-306-6627
Fax Number	:	480-306-6696

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA ADAMS
Credential	:
Telephone Number	:	480-306-6627

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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Directions to “MODERN SPORTS MEDICINE LLC ” Practice Location

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