Provider Demographics
NPI:1821367301
Name:TRIMARK PHYSICIANS GROUP
Entity Type:Organization
Organization Name:TRIMARK PHYSICIANS GROUP
Other - Org Name:UNITYPOINT CLINIC RADIOLOGY
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 1:802 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5740
Mailing Address - Country:US
Mailing Address - Phone:515-574-6605
Mailing Address - Fax:515-573-8710
Practice Address - Street 1:802 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5740
Practice Address - Country:US
Practice Address - Phone:515-574-6605
Practice Address - Fax:515-573-8710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIMARK PHYSICIANS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-29
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2400Medicare PIN