Healthcare Provider Details

I. General information

NPI: 1689650400
Provider Name (Legal Business Name): TRIMARK PHYSICIANS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MAIN ST
LAKE VIEW IA
51450-7717
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 712-657-8513
  • Fax:
Mailing address:
  • Phone: 515-574-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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