# TRI CITY COASTAL MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GREATER TRI CITIES IPA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1477142461
- **Legal business name:** GREATER TRI CITIES IPA
- **Authorized official:** MRS. GRACE BENDER (VICE PRESIDENT OF FINANCE)
- **Authorized official phone:** (760) 941-7309

## Contact information

- **Practice address:** 115 N EL CAMINO REAL STE A, OCEANSIDE, CA 92058-1844
- **Practice address phone:** (760) 941-7309
- **Mailing address:** 161 THUNDER DR STE 212, VISTA, CA 92083-6052
- **Mailing address phone:** (760) 941-7309

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 01/13/2021
- **Last updated:** 01/13/2021