Provider Demographics
NPI:1316077951
Name:TRILLIUM HEALTH CENTER
Entity type:Organization
Organization Name:TRILLIUM HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-653-0017
Mailing Address - Street 1:3484 CINCINNATI ZANESVILLE RD NE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3484 CINCINNATI ZANESVILLE RD NE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9308
Practice Address - Country:US
Practice Address - Phone:740-653-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043899B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC01691Medicare UPIN
OHH21838Medicare UPIN
OH0466323Medicare ID - Type UnspecifiedDR BLAHA
OH4029561Medicare ID - Type UnspecifiedDR CHAN
OH9276771Medicare ID - Type UnspecifiedTRILLIUM