Provider Demographics
NPI:1821243460
Name:TRINITY REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:TRINITY REGIONAL MEDICAL CENTER
Other - Org Name:TRINITY REGIONAL MEDICAL CENTER RENAL DIALYSIS
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:515-574-6603
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 1:821 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5445
Practice Address - Country:US
Practice Address - Phone:515-574-6200
Practice Address - Fax:515-574-6078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-24
Last Update Date:2008-12-01
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
IA162300Medicare Oscar/Certification