Healthcare Provider Details

I. General information

NPI: 1902165087
Provider Name (Legal Business Name): TRIHEALTH PHYSICIAN INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

PO BOX 635257
CINCINNATI OH
45263-5257
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-2864
  • Fax: 513-862-2573
Mailing address:
  • Phone: 513-862-2864
  • Fax: 513-862-2573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DONNA S NIENABER
Title or Position: SENIOR VP CORPORATE COUNSEL
Credential:
Phone: 513-569-6062