Provider Demographics
NPI:1528044344
Name:TRIMARK PHYSICIANS GROUP INC
Entity Type:Organization
Organization Name:TRIMARK PHYSICIANS GROUP INC
Other - Org Name:TRIMARK PHYSICIANS GROUP
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 1:24 N 9TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3905
Mailing Address - Country:US
Mailing Address - Phone:515-574-6890
Mailing Address - Fax:
Practice Address - Street 1:101 N MAIN
Practice Address - Street 2:
Practice Address - City:FONDA
Practice Address - State:IA
Practice Address - Zip Code:50540-7729
Practice Address - Country:US
Practice Address - Phone:712-288-4426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIMARK PHYSICIANS GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA168944Medicare Oscar/Certification