1912022302 NPI number — TRINITY MEDICAL CENTER

Table of content: (NPI 1912022302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912022302 NPI number — TRINITY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRINITY AT TERRACE PARK AMBULANCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912022302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8110 14TH ST W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK ISLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61201-7601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-787-2036
Provider Business Mailing Address Fax Number:
309-787-3795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 UTICA RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETTENDORF
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52722-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-742-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SPYROW
Authorized Official First Name:
FLORENCE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VICE PRESIDENT OF HOSPITAL OPERATIO
Authorized Official Telephone Number:
309-779-2329

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0200329 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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