Provider Demographics
NPI:1083030597
Name:TRIAD SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:TRIAD SURGERY CENTER, LLC
Other - Org Name:TRIAD EYE INSTITUTE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-252-2020
Mailing Address - Street 1:6140 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1933
Mailing Address - Country:US
Mailing Address - Phone:918-252-2020
Mailing Address - Fax:918-307-1983
Practice Address - Street 1:63223 E 290 RD
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-7552
Practice Address - Country:US
Practice Address - Phone:918-252-2020
Practice Address - Fax:918-307-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical