Provider Demographics
NPI:1568650174
Name:TRINITY REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:TRINITY REGIONAL MEDICAL CENTER
Other - Org Name:TRINITY REGIONAL MEDICAL CENTER DIALYSIS WEBSTER CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEGENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-574-6414
Mailing Address - Street 1:PO BOX 7021
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-7021
Mailing Address - Country:US
Mailing Address - Phone:515-362-5060
Mailing Address - Fax:
Practice Address - Street 1:1610 COLLINS ST
Practice Address - Street 2:SUITE D
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2623
Practice Address - Country:US
Practice Address - Phone:515-832-1667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA163515Medicare Oscar/Certification