Provider Demographics
NPI:1942344791
Name:TORREY PINES ORTHOPAEDIC MEDICAL GROUP INC
Entity Type:Organization
Organization Name:TORREY PINES ORTHOPAEDIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TPOMG
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:THUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-535-1075
Mailing Address - Street 1:9850 GENESEE AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1206
Mailing Address - Country:US
Mailing Address - Phone:858-535-1075
Mailing Address - Fax:858-453-9810
Practice Address - Street 1:9850 GENESEE AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1206
Practice Address - Country:US
Practice Address - Phone:858-535-1075
Practice Address - Fax:858-453-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
CAG24499207X00000X
CAC29014207X00000X
CAA43071207XS0106X
CAG47541207XS0114X
CAA72768207XS0117X
CAA96167207XX0004X
CAG75801207XX0005X
CAG54652207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W15730Medicare ID - Type Unspecified
W15730AMedicare ID - Type Unspecified
CA4473300002Medicare NSC