Healthcare Provider Details

I. General information

NPI: 1801887112
Provider Name (Legal Business Name): TRINITY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 02/17/2011
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

24 N 9TH ST SUITE A
FORT DODGE IA
50501-3905
US

V. Phone/Fax

Practice location:
  • Phone: 515-573-3101
  • Fax: 515-573-8710
Mailing address:
  • Phone: 515-574-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

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