Provider Demographics
NPI:1932809738
Name:TRIAD COMPLETE HEALTHCARE A06 LLC
Entity Type:Organization
Organization Name:TRIAD COMPLETE HEALTHCARE A06 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:BAYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:405-650-2110
Mailing Address - Street 1:1220 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4400
Mailing Address - Country:US
Mailing Address - Phone:405-650-2110
Mailing Address - Fax:405-372-2833
Practice Address - Street 1:1411 W 12TH AVE STE E
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5425
Practice Address - Country:US
Practice Address - Phone:405-650-2110
Practice Address - Fax:405-372-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care