Basic Information
| Provider Information | |||||||||
| NPI: | 1699190421 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIHEALTH W, LLC | ||||||||
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| OtherOrganizationName: | TRISTATE GYNECOLOGIC ONCOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635063 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138534731 | ||||||||
| FaxNumber: | 5135695199 | ||||||||
| Practice Location | |||||||||
| Address1: | 10550 MONTGOMERY RD | ||||||||
| Address2: | SUITE 22 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452424498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138621888 | ||||||||
| FaxNumber: | 5138623616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2014 | ||||||||
| LastUpdateDate: | 03/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | NIENABER | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP CORP COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 5135696062 | ||||||||
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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 | 207VX0201X | 35084002 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.