Provider Demographics
NPI:1679660179
Name:TRINITY WOMEN'S HEALTH CARE SC
Entity Type:Organization
Organization Name:TRINITY WOMEN'S HEALTH CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-786-1967
Mailing Address - Street 1:1310 N MAIN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1394
Mailing Address - Country:US
Mailing Address - Phone:815-786-1967
Mailing Address - Fax:815-786-1806
Practice Address - Street 1:1310 N MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1394
Practice Address - Country:US
Practice Address - Phone:815-786-1967
Practice Address - Fax:815-786-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072751Medicaid
IL214118Medicare PIN
ILC39058Medicare UPIN