Healthcare Provider Details

I. General information

NPI: 1821516568
Provider Name (Legal Business Name): TRINITY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 W 5TH ST
STORM LAKE IA
50588-3000
US

IV. Provider business mailing address

802 KENYON RD
FORT DODGE IA
50501-5740
US

V. Phone/Fax

Practice location:
  • Phone: 712-732-6650
  • Fax: 712-732-6632
Mailing address:
  • Phone: 515-574-6565
  • Fax: 515-574-6504

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: LEAH M GLASGO
Title or Position: MARKET PRESIDENT
Credential:
Phone: 515-573-3101