Healthcare Provider Details

I. General information

NPI: 1558737239
Provider Name (Legal Business Name): TRINITY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 KENYON RD STE 160A
FORT DODGE IA
50501-5742
US

IV. Provider business mailing address

802 KENYON RD
FORT DODGE IA
50501-5740
US

V. Phone/Fax

Practice location:
  • Phone: 515-574-6188
  • Fax:
Mailing address:
  • Phone: 515-574-6565
  • Fax: 515-574-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEAH H GLASGO
Title or Position: PRESIDENT & CEO
Credential:
Phone: 515-573-3101