Provider Demographics
NPI:1184644783
Name:TRINITY MEDICAL CENTER
Entity Type:Organization
Organization Name:TRINITY MEDICAL CENTER
Other - Org Name:TRINITY MEDXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE LEAD/COMPLIANCE COO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:563-742-5919
Mailing Address - Street 1:PMB 399
Mailing Address - Street 2:2884 DEVILS GLEN RD
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722
Mailing Address - Country:US
Mailing Address - Phone:563-742-5919
Mailing Address - Fax:563-742-5988
Practice Address - Street 1:2351 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-3329
Practice Address - Country:US
Practice Address - Phone:563-324-0133
Practice Address - Fax:563-324-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16951Medicare PIN