Organization
TRINITY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH PROVATEARE (DIRECTOR SUPPORT SERVICES)
(309) 779-2022
Entity
Organization
Contact information
Practice address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-3000
Mailing address
4600 3RD ST, MOLINE, IL 61265-6106
(309) 779-2032
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
273R00000X
Psychiatric Hospital Unit
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0219253
—
IA
05
—
0276170
—
IA
01
—
04049
BCWELLMARK ENRICH GR
—
01
—
8115303
BCILLINOIS RYC
—
01
—
99817
BCWELLMARK GROUP
—
01
—
CB8166
RR MEDICARE
IL
01
—
CB8516
RR MEDICARE
IL
01
—
CB8524
RR MEDICARE
IL
01
—
CB8530
RR MEDICARE
IL
01
—
CK0834
RR MEDICARE
IL
Enumeration date
05/19/2006
Last updated
04/11/2017
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