Provider Demographics
NPI:1104344845
Name:TRINITY REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:TRINITY REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEWERFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-573-3101
Mailing Address - Street 1:802 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5740
Mailing Address - Country:US
Mailing Address - Phone:515-574-6565
Mailing Address - Fax:515-574-6504
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FONDA
Practice Address - State:IA
Practice Address - Zip Code:50540-7729
Practice Address - Country:US
Practice Address - Phone:712-228-4426
Practice Address - Fax:712-228-4425
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-01
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health