Provider Demographics
NPI:1881810844
Name:OMEGA ORTHOPAEDICS, INC
Entity type:Organization
Organization Name:OMEGA ORTHOPAEDICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-634-0123
Mailing Address - Street 1:203 S. CANDY LANE
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-8107
Mailing Address - Country:US
Mailing Address - Phone:928-634-0123
Mailing Address - Fax:928-634-0123
Practice Address - Street 1:203 S. CANDY LANE
Practice Address - Street 2:SUITE 4B
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-8107
Practice Address - Country:US
Practice Address - Phone:928-634-0123
Practice Address - Fax:928-634-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09582207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ203943Medicaid
AZAZ0008170OtherBCBSAZ
AZD38807Medicare UPIN
AZZ62689Medicare ID - Type UnspecifiedMEDICARE