Provider Demographics
NPI:1881791283
Name:TRINITY REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:TRINITY REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
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 35515
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-0305
Mailing Address - Country:US
Mailing Address - Phone:515-557-3100
Mailing Address - Fax:515-557-3159
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:515-574-6416
Practice Address - Fax:515-574-6985
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA67149OtherWELLMARK BCBS
IA0671495Medicaid
IA167149Medicare Oscar/Certification