Provider Demographics
NPI:1881963825
Name:TRINITY HEALTH ENTERPRISES INC
Entity type:Organization
Organization Name:TRINITY HEALTH ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAUWELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-779-4663
Mailing Address - Street 1:106 19TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3700
Mailing Address - Country:US
Mailing Address - Phone:309-779-4663
Mailing Address - Fax:309-779-5644
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:309-779-5625
Practice Address - Fax:309-779-5629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1473011OtherUNITED HEALTHCARE
IL08170524OtherBLUE CROSS BLUE SHIELD IL
IA0994046Medicaid
605197300OtherDEPARTMENT OF LABOR
IA96467OtherWELLMARK BCBS OF IA
IL=========002Medicaid
IA0994046Medicaid
IL0441500001Medicare NSC