Basic Information
| Provider Information | |||||||||
| NPI: | 1063776714 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRIHEALTH OS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TRIHEALTH ORTHOPAEDIC & SPINE INSTITUTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8311 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452362227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139853700 | ||||||||
| FaxNumber: | 5139853706 | ||||||||
| Practice Location | |||||||||
| Address1: | 8311 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452362227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139853700 | ||||||||
| FaxNumber: | 5139853706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2012 | ||||||||
| LastUpdateDate: | 12/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | NIENABER | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY OF SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5135696062 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0071661 | 05 | OH | MEDICAID |