Basic Information
| Provider Information | |||||||||
| NPI: | 1770875056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIHEALTH W. LLC | ||||||||
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| OtherOrganizationName: | GYN/ONC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635063 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138621888 | ||||||||
| FaxNumber: | 5138623616 | ||||||||
| Practice Location | |||||||||
| Address1: | 3219 CLIFTON AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452203027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138621888 | ||||||||
| FaxNumber: | 5138623616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2011 | ||||||||
| LastUpdateDate: | 07/20/2011 | ||||||||
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| AuthorizedOfficialLastName: | NIENABER | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP CORPORATE COUNCIL | ||||||||
| AuthorizedOfficialTelephone: | 5135696062 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207VX0201X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.