Provider Demographics
NPI:1487759858
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLASGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-573-3101
Mailing Address - Street 1:802 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5740
Mailing Address - Country:US
Mailing Address - Phone:515-573-3101
Mailing Address - Fax:515-573-8710
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:515-573-3101
Practice Address - Fax:515-573-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA940001H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010852200Medicaid
NE10025083300Medicaid
IA60016OtherBLUE CROSS ACUTE
WI80538000Medicaid
SD0124870Medicaid
IAA5050101OtherJOHN DEERE
IA0600163Medicaid
SD5524870Medicaid
SD5524870Medicaid
WI80538000Medicaid
SD0124870Medicaid