1831500891 NPI number — TRIHEALTH PHYSICIANS OF INDIANA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831500891 NPI number — TRIHEALTH PHYSICIANS OF INDIANA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIHEALTH PHYSICIANS OF INDIANA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831500891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 638224
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-8224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-853-4749
Provider Business Mailing Address Fax Number:
513-853-4940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
256 S. STATE ROUTE 129
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47006-9236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-934-6428
Provider Business Practice Location Address Fax Number:
812-934-6122
Provider Enumeration Date:
05/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
NIENABER
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. VP CORP COUNSEL
Authorized Official Telephone Number:
513-569-6062

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201163730C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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