Healthcare Provider Details

I. General information

NPI: 1740886282
Provider Name (Legal Business Name): TRINITY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 KENYON RD
FORT DODGE IA
50501-5740
US

IV. Provider business mailing address

802 KENYON RD
FORT DODGE IA
50501-5740
US

V. Phone/Fax

Practice location:
  • Phone: 515-573-3101
  • Fax: 515-573-8710
Mailing address:
  • Phone: 515-573-3101
  • Fax: 515-573-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: LEAH M GLASGO
Title or Position: CEO
Credential:
Phone: 515-573-3101