Basic Information
| Provider Information | |||||||||
| NPI: | 1184915068 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIHEALTH W. LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636406 | ||||||||
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| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452630001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138534749 | ||||||||
| FaxNumber: | 5138534740 | ||||||||
| Practice Location | |||||||||
| Address1: | 7759 UNIVERSITY DR | ||||||||
| Address2: | SUITE D | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450696578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135696422 | ||||||||
| FaxNumber: | 5135695199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2011 | ||||||||
| LastUpdateDate: | 03/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | AYLWARD | ||||||||
| AuthorizedOfficialFirstName: | CONNIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN COMPLIANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5135696302 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0201X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 208800000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | 363LX0001X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207VM0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VG0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7100189620 | 05 | KY | MEDICAID | 7100253770 | 05 | KY | MEDICAID | 7100259480 | 05 | KY | MEDICAID | 7100189900 | 05 | KY | MEDICAID |