Provider Demographics
NPI:1710022033
Name:OASIS ORTHOPEDICS, LTD
Entity Type:Organization
Organization Name:OASIS ORTHOPEDICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAAGEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-833-0204
Mailing Address - Street 1:1450 S DOBSON RD
Mailing Address - Street 2:SUITE B-122
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4712
Mailing Address - Country:US
Mailing Address - Phone:480-833-0204
Mailing Address - Fax:480-835-1021
Practice Address - Street 1:1450 S DOBSON RD
Practice Address - Street 2:SUITE B-122
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4712
Practice Address - Country:US
Practice Address - Phone:480-833-0204
Practice Address - Fax:480-835-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZB02609Medicaid
AZB02609Medicaid