Provider Demographics
NPI:1861451445
Name:TRI-CITY ORTHOPAEDIC SURGERY MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:TRI-CITY ORTHOPAEDIC SURGERY MEDICAL GROUP INC.
Other - Org Name:ORTHOPAEDIC SPECIALISTS OF NORTH COUNTY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-724-9000
Mailing Address - Street 1:3905 WARING RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4405
Mailing Address - Country:US
Mailing Address - Phone:760-724-9000
Mailing Address - Fax:760-724-3686
Practice Address - Street 1:3905 WARING RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4405
Practice Address - Country:US
Practice Address - Phone:760-724-9000
Practice Address - Fax:760-724-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ72841ZMedicaid
CAZZZ72841ZMedicaid
CAW210Medicare PIN
CA0876000001Medicare NSC