Provider Demographics
NPI:1154376622
Name:TRIHEALTH PHYSICIAN PRACTICES, LLC
Entity type:Organization
Organization Name:TRIHEALTH PHYSICIAN PRACTICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NIENABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-569-6386
Mailing Address - Street 1:PO BOX 635156
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5156
Mailing Address - Country:US
Mailing Address - Phone:513-569-6386
Mailing Address - Fax:513-569-6320
Practice Address - Street 1:100 ARROW SPRINGS BLVD
Practice Address - Street 2:SUITE 2800
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036
Practice Address - Country:US
Practice Address - Phone:513-282-7300
Practice Address - Fax:513-282-7310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIHEALTH PHYSICIAN PRACTICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2549942Medicaid
OH2549942Medicaid
OH9351864Medicare PIN