Healthcare Provider Details

I. General information

NPI: 1184915068
Provider Name (Legal Business Name): TRIHEALTH W. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7759 UNIVERSITY DR SUITE D
WEST CHESTER OH
45069-6578
US

IV. Provider business mailing address

PO BOX 636406
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-6422
  • Fax: 513-569-5199
Mailing address:
  • Phone: 513-853-4749
  • Fax: 513-853-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CONNIE AYLWARD
Title or Position: PHYSICIAN COMPLIANCE OFFICER
Credential:
Phone: 513-569-6302