Provider Demographics
NPI:1922051697
Name:TRIHEALTH PHYSICIAN INSTITUTE
Entity Type:Organization
Organization Name:TRIHEALTH PHYSICIAN INSTITUTE
Other - Org Name:GEROS PHYSICIAN EXTENDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
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:513-862-1400
Mailing Address - Street 1:PO BOX 635257
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5257
Mailing Address - Country:US
Mailing Address - Phone:513-569-5027
Mailing Address - Fax:513-569-5199
Practice Address - Street 1:619 OAK ST
Practice Address - Street 2:4 - WEST
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1613
Practice Address - Country:US
Practice Address - Phone:513-569-6780
Practice Address - Fax:513-569-6738
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIHEALTH PHYSICIAN INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001078363A00000X
OHNP06244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0998783Medicaid
OH9273041Medicare PIN