Provider Demographics
NPI:1285684423
Name:TRINITY MEDICAL CENTER
Entity Type:Organization
Organization Name:TRINITY MEDICAL CENTER
Other - Org Name:TRINITY MEDICAL CENTER DBA TRINITY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGLIUZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-779-2218
Mailing Address - Street 1:4469 48TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-9213
Mailing Address - Country:US
Mailing Address - Phone:309-779-7020
Mailing Address - Fax:309-787-3795
Practice Address - Street 1:4469 48TH AVENUE CT
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-9213
Practice Address - Country:US
Practice Address - Phone:309-779-7020
Practice Address - Fax:309-787-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL229783416L0300X, 343900000X
IA20010003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========011Medicaid
IL213444Medicare ID - Type UnspecifiedPROVIDER NUMBER