Healthcare Provider Details

I. General information

NPI: 1124183785
Provider Name (Legal Business Name): TRINITY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 KENYON RD
FORT DODGE IA
50501-5740
US

IV. Provider business mailing address

PO BOX 7021
DES MOINES IA
50309-7021
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number940001H
License Number StateIA

VIII. Authorized Official

Name: MR. MIKE J DEWERFF
Title or Position: CFO
Credential:
Phone: 515-574-6603