Healthcare Provider Details

I. General information

NPI: 1699190421
Provider Name (Legal Business Name): TRIHEALTH W, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 MONTGOMERY RD SUITE 22
CINCINNATI OH
45242-4498
US

IV. Provider business mailing address

PO BOX 635063
CINCINNATI OH
45263-5063
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-1888
  • Fax: 513-862-3616
Mailing address:
  • Phone: 513-853-4731
  • Fax: 513-569-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number35084002
License Number StateOH

VIII. Authorized Official

Name: MRS. DONNA NIENABER
Title or Position: SR VP CORP COUNSEL
Credential:
Phone: 513-569-6062