Provider Demographics
NPI:1003108267
Name:TRIHEALTH W. LLC,
Entity Type:Organization
Organization Name:TRIHEALTH W. LLC,
Other - Org Name:DR MARIANNA VARDAKA
Other - Org Type:Other Name
Authorized Official - Title/Position:SR VP CORP COUNCIL
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NIENABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-569-6062
Mailing Address - Street 1:PO BOX 636358
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6358
Mailing Address - Country:US
Mailing Address - Phone:513-985-9017
Mailing Address - Fax:513-985-9036
Practice Address - Street 1:10495 MONTGOMERY RD
Practice Address - Street 2:SUITE 16
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4468
Practice Address - Country:US
Practice Address - Phone:513-985-9017
Practice Address - Fax:513-985-9036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty