Provider Demographics
NPI:1215054986
Name:TRIHEALTH PHYSICIAN INSTITUTE
Entity type:Organization
Organization Name:TRIHEALTH PHYSICIAN INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT
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:513-862-1400
Mailing Address - Street 1:PO BOX 632874
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2874
Mailing Address - Country:US
Mailing Address - Phone:513-569-5027
Mailing Address - Fax:513-569-5199
Practice Address - Street 1:619 OAK ST
Practice Address - Street 2:4 WEST
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1613
Practice Address - Country:US
Practice Address - Phone:513-569-6116
Practice Address - Fax:513-569-6110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIHEALTH PHYSICIAN INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2448202Medicaid
OH9335094Medicare PIN