Provider Demographics
NPI:1073594156
Name:TRINITY REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:TRINITY REGIONAL MEDICAL CENTER
Other - Org Name:UNITYPOINT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLASGO
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:515-573-3101
Mailing Address - Fax:515-573-8710
Practice Address - Street 1:802 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5740
Practice Address - Country:US
Practice Address - Phone:515-573-3101
Practice Address - Fax:515-573-8710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-07
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0269597Medicaid
IA26959Medicare PIN