Provider Demographics
NPI:1467528018
Name:TRIMARK PHYSICIANS GROUP INC
Entity Type:Organization
Organization Name:TRIMARK PHYSICIANS GROUP INC
Other - Org Name:TRIMARK PHYSICIANS GROUP INC - ARNP
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 1:800 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5776
Mailing Address - Country:US
Mailing Address - Phone:515-573-4141
Mailing Address - Fax:
Practice Address - Street 1:800 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5776
Practice Address - Country:US
Practice Address - Phone:515-573-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH SYSTEMS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-27
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0424929Medicaid