Provider Demographics
NPI:1962788331
Name:A-1 ORTHOPEDIC, LLC
Entity type:Organization
Organization Name:A-1 ORTHOPEDIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:2501 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7669
Mailing Address - Country:US
Mailing Address - Phone:480-299-7908
Mailing Address - Fax:480-835-1021
Practice Address - Street 1:2501 E SOUTHERN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7669
Practice Address - Country:US
Practice Address - Phone:480-299-7908
Practice Address - Fax:480-835-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29248207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ563016Medicaid
AZ65596OtherMEDICARE ID
AZAZ0884660OtherBCBS
AZH36907Medicare UPIN