Healthcare Provider Details

I. General information

NPI: 1770875056
Provider Name (Legal Business Name): TRIHEALTH W. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 CLIFTON AVE SUITE 100
CINCINNATI OH
45220-3027
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: 513-862-1888
  • Fax: 513-862-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

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