Basic Information
Provider Information | |||||||||
NPI: | 1588954556 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TRINITY HOME HEALTH SERVICES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MERCYONE DES MOINES HOME INFUSION | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6281 TRI RIDGE BLVD STE 300 | ||||||||
Address2: |   | ||||||||
City: | LOVELAND | ||||||||
State: | OH | ||||||||
PostalCode: | 451408345 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5135760262 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2853 99TH ST | ||||||||
Address2: |   | ||||||||
City: | URBANDALE | ||||||||
State: | IA | ||||||||
PostalCode: | 503223858 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5153318947 | ||||||||
FaxNumber: | 5153318986 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/12/2011 | ||||||||
LastUpdateDate: | 09/29/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MCPHERSON | ||||||||
AuthorizedOfficialFirstName: | MARK | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
AuthorizedOfficialTelephone: | 7343432646 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/29/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251F00000X |   |   | Y |   | Agencies | Home Infusion |   |
ID Information
ID | Type | State | Issuer | Description | 1107900 | 01 | IA | CONTROLLED SUBSTANCE | OTHER | 1624433 | 01 |   | NCPDP | OTHER | 0212212 | 05 | IA |   | MEDICAID | 1396 | 01 | IA | PHARMACY | OTHER | FM2811784 | 01 | IA | DEA | OTHER |