Provider Demographics
NPI:1114282779
Name:SYNERGY ORTHOPEDIC SPECIALISTS, INC.
Entity Type:Organization
Organization Name:SYNERGY ORTHOPEDIC SPECIALISTS, INC.
Other - Org Name:SYNERGY ORTHOPEDIC SPECIALISTS MEDICAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-412-6080
Mailing Address - Street 1:4445 EASTGATE MALL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1979
Mailing Address - Country:US
Mailing Address - Phone:858-412-6080
Mailing Address - Fax:858-412-6376
Practice Address - Street 1:4910 DIRECTORS PL STE 350
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3834
Practice Address - Country:US
Practice Address - Phone:858-357-9450
Practice Address - Fax:858-412-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty