Healthcare Provider Details

I. General information

NPI: 1083030597
Provider Name (Legal Business Name): TRIAD SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63223 E 290 RD
GROVE OK
74344-7552
US

IV. Provider business mailing address

6140 S MEMORIAL DR
TULSA OK
74133-1933
US

V. Phone/Fax

Practice location:
  • Phone: 918-252-2020
  • Fax: 918-307-1983
Mailing address:
  • Phone: 918-252-2020
  • Fax: 918-307-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN PATRICK CONLEY
Title or Position: OWNER
Credential:
Phone: 918-252-2020