Healthcare Provider Details

I. General information

NPI: 1871845446
Provider Name (Legal Business Name): TRIHEALTH DIGESTIVE DISEASES INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 MONTGOMERY RD SUITE 200
CINCINNATI OH
45242-4463
US

IV. Provider business mailing address

PO BOX 637910
CINCINNATI OH
45263-7910
US

V. Phone/Fax

Practice location:
  • Phone: 513-794-5600
  • Fax: 513-281-1908
Mailing address:
  • Phone: 513-794-5600
  • Fax: 513-281-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology 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