Provider Demographics
NPI:1306904180
Name:CORE ORTHOPAEDIC MEDICAL CENTER
Entity type:Organization
Organization Name:CORE ORTHOPAEDIC MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-632-4240
Mailing Address - Street 1:332 SANTA FE DRIVE
Mailing Address - Street 2:STE 110
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-943-6700
Mailing Address - Fax:
Practice Address - Street 1:332 SANTA FE DRIVE
Practice Address - Street 2:STE 110
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-943-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0093170Medicaid
CAZZZ04918ZOtherBLUE SHIELD
CAGR0093170Medicaid
CAGR0093170Medicaid