Basic Information
| Provider Information | |||||||||
| NPI: | 1518373570 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIHEALTH PHYSICIAN PRACTICES LLC | ||||||||
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| OtherOrganizationName: | TRIHEALTH PHYSICIAN PARTNERS GERIATRIC MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 637676 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452637676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138534684 | ||||||||
| FaxNumber: | 5138534743 | ||||||||
| Practice Location | |||||||||
| Address1: | 4750 WESLEY AVE | ||||||||
| Address2: | SUITE J | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135315110 | ||||||||
| FaxNumber: | 5135311327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2014 | ||||||||
| LastUpdateDate: | 07/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | NIENABER | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VP CORPORATE COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 5135696062 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TRIHEALTH PHYSICIAN PRACTICES LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.