MEDICARE: TRIHEALTH PHYSICIAN PRACTICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407800642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIHEALTH PHYSICIAN PRACTICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 637676
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-7676
Country	:	US
Telephone Number	:	513-561-6266
Fax Number	:

Provider Business Practice Location Address
First Line	:	7829 LAUREL AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45243-2608
Country	:	US
Telephone Number	:	513-561-6266
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	MS. DONNA S NIENABER
Credential	:
Telephone Number	:	513-862-1400

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/18/2013

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