Provider Demographics
NPI:1982770996
Name:TRINITY HEALTH
Entity Type:Organization
Organization Name:TRINITY HEALTH
Other - Org Name:VISION GALLERIA (MINOT)
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-857-5000
Mailing Address - Street 1:PO BOX 5020
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5020
Mailing Address - Country:US
Mailing Address - Phone:701-857-5118
Mailing Address - Fax:
Practice Address - Street 1:2815 16TH ST SW STE 101
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6914
Practice Address - Country:US
Practice Address - Phone:701-857-7440
Practice Address - Fax:701-857-7442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-28
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1464079Medicaid