Community Medical Services Arizona-Private, LLC
Organization Active NPI Methadone Clinic · Show Low, AZ
NPI 1053978460 · NPPES record last updated Aug 20, 2025
Key facts
- NPI
- 1053978460
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Methadone Clinic 261QM2800X
- Legal business name
- COMMUNITY MEDICAL SERVICES ARIZONA-PRIVATE, LLC
- Practice address
- 1500 E Woolford Road
Suite 101
Show Low, AZ 85901-7105 - Phone
- (928) 251-2030
- Fax
- (928) 892-5103
- NPI assigned
- May 21, 2019
- Organization subpart
- No
Authorized official
- Name
- Nick Stavros
- Title
- Ceo
- Phone
- (602) 248-8886
Other NPIs on the same Medicare enrollment 26
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Opioid treatment program
- Medicare-enrolled since Jan 1, 2020
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200416000394 | AZ | Part B Supplier - Opioid Treatment Program (Otp) | 1759711625 |
26 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tucson, AZ; Yuma, AZ; Tempe, AZ; Sierra Vista, AZ; Show Low, AZ; Safford, AZ; Prescott Valley, AZ; Phoenix, AZ… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | |||
| Community/Behavioral Health Agency | 251S00000X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Methadone Clinic | 261QM2800X | Yes | ||
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X |
Addresses
Primary practice location
1500 E Woolford Road
Suite 101
Show Low, AZ 85901-7105
Mailing address
8444 N 90TH St Ste 100
Scottsdale, AZ 85258-4437
Phone (602) 248-8886
Other names
- Community Medical Services-Show Low
Other providers in Show Low, AZ
- Coast to Coast Air Ambulance, LLC
- Apache Colelay
- Judith Ann Collier
- Constance L Collman
- Community Counseling Centers Inc
- Community Medical Services Arizona-Private, LLC
- Comprehensive Hospitalist Services of Arizona LLC
- Comprehensive Hospitalist Services of Arizona, LLC
- Connelly Care PLLC
- Patrick Wellington Connelly
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.