Provider Demographics
NPI:1174857791
Name:TRIAD CLINIC PLLC
Entity Type:Organization
Organization Name:TRIAD CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:602-667-4636
Mailing Address - Street 1:5350 W BELL RD
Mailing Address - Street 2:SUITE C-122-417
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3906
Mailing Address - Country:US
Mailing Address - Phone:602-667-4636
Mailing Address - Fax:480-247-5551
Practice Address - Street 1:4902 W IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-2402
Practice Address - Country:US
Practice Address - Phone:602-667-4636
Practice Address - Fax:480-247-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3175208D00000X
AZAP2115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty