Provider Demographics
NPI:1568414134
Name:TRINITY MEDICAL CENTER
Entity Type:Organization
Organization Name:TRINITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEGAL COUNSEL
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPYROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-779-2219
Mailing Address - Street 1:2701 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5351
Mailing Address - Country:US
Mailing Address - Phone:309-779-5000
Mailing Address - Fax:
Practice Address - Street 1:2701 17TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5351
Practice Address - Country:US
Practice Address - Phone:309-779-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8115303OtherBCILLINOIS GROUP
91433OtherBCWELLMARK E MOLINE
91471OtherBCWELLMARK 7TH STREET
IACK7064OtherRR MEDICARE GROUP
95149OtherBCWELLMARK EKG GROUP
ILCH3653OtherRR MEDICARE GROUP
92323OtherBCWELLMARK WEST
97622OtherBCWELLMARK MOLINE
IA0219253Medicaid
IA0219253Medicaid
CB8514Medicare ID - Type UnspecifiedRR MEDICARE GROUP
95149OtherBCWELLMARK EKG GROUP
IACK7064OtherRR MEDICARE GROUP
8115303OtherBCILLINOIS GROUP