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General NPI Number Information
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NPI Number | 1477290591
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Entity Type | Organization
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Legal Business Name | TRIAD PEDIATRICS, LLC
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1001 HOSPITAL CIR
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City | KINGFISHER
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State | OK
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Zip | 73750-5002
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Country | US
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Telephone | 405-375-7935
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Fax |
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Provider Business Mailing Address
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Address Line | 2703 N 14TH ST
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City | PONCA CITY
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State | OK
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Zip | 74601-1738
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Country | US
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Telephone | 580-765-9451
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MATT BINTZ
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Credential |
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Telephone | 580-765-3055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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