Basic Information
| Provider Information | |||||||||
| NPI: | 1528225760 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRINITY MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ROBERT YOUNG CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 17TH ST | ||||||||
| Address2: | |||||||||
| City: | ROCK ISLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612015351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097795000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4600 3RD ST | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097792031 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 05/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | SPYROW | ||||||||
| AuthorizedOfficialFirstName: | FLORENCE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 3097792219 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 276400000X | 1813322 | IL | N | Hospital Units | Rehabilitation, Substance Use Disorder Unit | 273R00000X | 1813322 | IL | Y | Hospital Units | Psychiatric Unit |
No ID Information.