Provider Demographics
NPI:1871833145
Name:TRIHEALTH Q, LLC
Entity Type:Organization
Organization Name:TRIHEALTH Q, LLC
Other - Org Name:QUEEN CITY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:COYLE-TOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:513-246-8005
Mailing Address - Street 1:3035 HAMILTON MASON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5544
Mailing Address - Country:US
Mailing Address - Phone:513-738-0500
Mailing Address - Fax:
Practice Address - Street 1:3035 HAMILTON MASON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-5544
Practice Address - Country:US
Practice Address - Phone:513-738-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TPEC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000000208000000X
OH00000000261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2623209Medicaid