Healthcare Provider Details

I. General information

NPI: 1285684423
Provider Name (Legal Business Name): TRINITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4469 48TH AVENUE CT
ROCK ISLAND IL
61201-9213
US

IV. Provider business mailing address

4469 48TH AVENUE CT
ROCK ISLAND IL
61201-9213
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-7020
  • Fax: 309-787-3795
Mailing address:
  • Phone: 309-779-7020
  • Fax: 309-787-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2001000
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number22978
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number22978
License Number StateIL

VIII. Authorized Official

Name: MR. GREGORY PAGLIUZZA
Title or Position: CFO
Credential:
Phone: 309-779-2218