Provider Demographics
NPI:1174654578
Name:TRIHEALTH G., LLC
Entity Type:Organization
Organization Name:TRIHEALTH G., LLC
Other - Org Name:GROUP HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKLIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-841-5535
Mailing Address - Street 1:4600 WESLEY AVE
Mailing Address - Street 2:STE N
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2298
Mailing Address - Country:US
Mailing Address - Phone:513-841-5519
Mailing Address - Fax:513-841-1580
Practice Address - Street 1:100 ARROW SPRINGS BLVD
Practice Address - Street 2:STE 2600
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9863
Practice Address - Country:US
Practice Address - Phone:513-872-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIHEALTH G LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2686517Medicaid