Provider Demographics
NPI:1336231992
Name:TRINITY MEDICAL CENTER
Entity Type:Organization
Organization Name:TRINITY MEDICAL CENTER
Other - Org Name:TRINITY TRANSITIONAL CARE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-779-5000
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?:Yes
Parent Organization LBN:TRINITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-29
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1745008314000000X
IL2087325314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0901363Medicaid
IL45564OtherBLUE CROSS
IL45564OtherBLUE CROSS