1871885038 NPI number — TRIHEALTH W. LLC,

Table of content: (NPI 1871885038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871885038 NPI number — TRIHEALTH W. LLC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIHEALTH W. LLC,
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:
1871885038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 637407
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:
45263-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-487-4693
Provider Business Mailing Address Fax Number:
513-487-4590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3440 BURNET AVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45229-2843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-487-4593
Provider Business Practice Location Address Fax Number:
513-487-4590
Provider Enumeration Date:
05/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NIENABER
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SR VP CORPORATE COUNCIL
Authorized Official Telephone Number:
513-569-6062

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3156141 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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