NPIMap

Organization Active NPI

Trinity Hospital Twin City

  • Rural Health Clinic/Center
  • Gnadenhutten, OH
National Provider Identifier
1104265792
Registry record updated Jun 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
2001194 Issued in OH
Legal business name
TRINITY HOSPITAL TWIN CITY
Practice address
110 North Walnut Street
Gnadenhutten, OH 44629
Phone
(740) 254-9443
Fax
(740) 254-9445
NPI assigned
Jun 18, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robin Brown
Title
Practice Administrator
Phone
(740) 922-7450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 2001194 OH Primary

Addresses

Primary practice location

110 North Walnut Street
Gnadenhutten, OH 44629

Mailing address

819 N 1St St
Dennison, OH 44621-1003
Phone (740) 922-0000

Other names 1

  • Trinity Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131108001219 OH Part A Provider - Rural Health Clinic 6204004534 Practice locations: Gnadenhutten, OH

Rural health clinic certification: CCN 363997

Legal name
TRINITY HOSPITAL TWIN CITY
Doing business as
TWIN CITY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 25, 2014
Last certification
Oct 13, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 2, 2011 in OH
Enrollment address
110 N Walnut St
Gnadenhutten, OH 44629-9714
Related CCNs
361302

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D1044220Trinity Medical Group Gnadenhutten110 N Walnut St, Gnadenhutten, OH 44629Certificate of waiverAug 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Trinity Hospital Twin City5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John N Figel Individual Corporate DirectorBoard Member Jan 1, 2013
Jerry Simpson Individual Corporate DirectorBoard Member Aug 14, 2017
Sylvania Franciscan Health Organization, Toledo, OH Non-profit 5% Or Greater Indirect Ownership Interest May 10, 2011 50%
Dan Daily Individual Corporate DirectorBoard Member Aug 14, 2017
Matthew a Colflesh Individual Corporate OfficerPresident Elect Medical Staff Aug 14, 2017
Brent Mallek Individual Corporate OfficerVP Human Resources Aug 14, 2017
Commonspirit Health Organization, Englewood, CO Non-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2014 100%
Rachel Maxwell Individual W-2 Managing EmployeeSenior Practice Manager Jan 1, 2022
Trinity Health System Organization, Steubenville, OH Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2017 100%
Matthew L Grimshaw Individual Corporate OfficerCeo Jul 31, 2017
Lloyd H Dean Individual Operational/Managerial ControlChain Home Office Administrator Jul 1, 2021
Sheila Hendricks Individual Corporate DirectorBoard Member Aug 14, 2017
Eric Exley Individual Corporate OfficerSecretary Aug 14, 2017
Diana Eckel Individual Corporate DirectorBoard Member Aug 14, 2017
Dave Werkin Individual Corporate OfficerCfo Aug 14, 2017
Mark Morelli Individual Corporate DirectorBoard Member Aug 14, 2017
James Padden Individual Corporate OfficerVice Chairperson Aug 14, 2017
Corporate DirectorBoard Member Jul 1, 2017
Dennis Wolters Individual Corporate DirectorBoard Member May 1, 2011
Larry P Schumacher Individual Corporate DirectorBoard Member Aug 14, 2017
William Schaefer Individual Corporate DirectorBoard Member Aug 14, 2017
John Columbus Individual Corporate OfficerPresident Medical Staff Aug 14, 2017
Michael Biasi Individual Corporate DirectorBoard Member Aug 14, 2017
David Skiviat Individual Corporate DirectorBoard Member Aug 14, 2017
Dwayne Richardson Individual Corporate OfficerPresident Mar 8, 2021
W-2 Managing EmployeePresident Mar 8, 2021

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 18

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371513600000",
    "number": "1104265792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 N 1ST ST",
            "city": "DENNISON",
            "state": "OH",
            "postal_code": "446211003",
            "telephone_number": "740-922-0000",
            "fax_number": "740-922-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 NORTH WALNUT STREET",
            "city": "GNADENHUTTEN",
            "state": "OH",
            "postal_code": "44629",
            "telephone_number": "740-254-9443",
            "fax_number": "740-254-9445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY HOSPITAL TWIN CITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-18",
        "last_updated": "2013-06-18",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "740-922-7450"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "OH",
            "license": "2001194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trinity Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gnadenhutten, OH

Sources for this page

Verify at the official NPI Registry.