Basic Information
| Provider Information | |||||||||
| NPI: | 1598710881 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BETHESDA HOSPITAL, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TRIHEALTH NURSE MIDWIVES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 633370 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452633370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135695027 | ||||||||
| FaxNumber: | 5135695199 | ||||||||
| Practice Location | |||||||||
| Address1: | 3440 BURNET AVE | ||||||||
| Address2: | STE. 120 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452292833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137515900 | ||||||||
| FaxNumber: | 5134874590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 04/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | NIENABER | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5138621400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 78903101 | 05 | KY | MEDICAID | 200409040A | 05 | IN | MEDICAID | 2441950 | 05 | OH | MEDICAID | 2518001 | 05 | OH | MEDICAID | 200409040C | 05 | IN | MEDICAID | 200409040B | 05 | IN | MEDICAID | 2358498 | 05 | OH | MEDICAID |