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General NPI Number Information
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NPI Number | 1881810844
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Entity Type | Organization
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Legal Business Name | OMEGA ORTHOPAEDICS, INC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 203 S. CANDY LANE SUITE 4B
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City | COTTONWOOD
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State | AZ
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Zip | 86326-8107
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Country | US
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Telephone | 928-634-0123
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Fax | 928-634-0123
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Provider Business Mailing Address
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Address Line | 203 S. CANDY LANE SUITE 4B
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City | COTTONWOOD
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State | AZ
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Zip | 86326-8107
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Country | US
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Telephone | 928-634-0123
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Fax | 928-634-0123
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. THOMAS JOSEPH PETERS
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Credential | MD
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Telephone | 928-634-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 09582
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License Number State | AZ
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