Healthcare Provider Details

I. General information

NPI: 1922051697
Provider Name (Legal Business Name): TRIHEALTH PHYSICIAN INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 OAK ST 4 - WEST
CINCINNATI OH
45206-1613
US

IV. Provider business mailing address

PO BOX 635257
CINCINNATI OH
45263-5257
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-6780
  • Fax: 513-569-6738
Mailing address:
  • Phone: 513-569-5027
  • Fax: 513-569-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50001078
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP06244
License Number StateOH

VIII. Authorized Official

Name: DONNA S NIENABER
Title or Position: VICE PRESIDENT
Credential:
Phone: 513-862-1400