Provider Demographics
NPI:1518364165
Name:TRI CITY PRIMARY CARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:TRI CITY PRIMARY CARE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING & COLLECTIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLPHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-477-2101
Mailing Address - Street 1:1926 VIA CENTRE DRIVE
Mailing Address - Street 2:STE A
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6056
Mailing Address - Country:US
Mailing Address - Phone:760-940-7000
Mailing Address - Fax:760-940-0042
Practice Address - Street 1:1926 VIA CENTRE DRIVE
Practice Address - Street 2:STE A
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6056
Practice Address - Country:US
Practice Address - Phone:760-940-7000
Practice Address - Fax:760-940-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty