Provider Demographics
NPI:1033527114
Name:TRIMARK PHYSICIANS GROUP
Entity Type:Organization
Organization Name:TRIMARK PHYSICIANS GROUP
Other - Org Name:UNITYPOINT CLINIC-PEDIATRICS-FORT DODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEWERFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-574-6603
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:515-574-6890
Mailing Address - Fax:515-574-6458
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:STE D
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5744
Practice Address - Country:US
Practice Address - Phone:515-574-6855
Practice Address - Fax:515-573-7274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIMARK PHYSICIANS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-01
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health