1982042743 NPI number — TRIHEALTH W LLC

Table of content: MISS MICHELLE MOINIFAR O.D. (NPI 1023430477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982042743 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:
1982042743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
375 DIXMYTH AVE
Provider Second Line Business Mailing Address:
8TH FLOOR
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45220-2475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-862-6200
Provider Business Mailing Address Fax Number:
513-862-4358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 DIXMYTH AVE
Provider Second Line Business Practice Location Address:
8TH FLOOR
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45220-2475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-862-6200
Provider Business Practice Location Address Fax Number:
513-862-4358
Provider Enumeration Date:
06/13/2013

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 CORP COUNSEL
Authorized Official Telephone Number:
513-569-6062

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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