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NPI Code Detail

MEDICARE: TRIAD SURGERY CENTER LLC

MEDICARE: TRIAD SURGERY CENTER LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1205439650
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRIAD SURGERY CENTER LLC
Provider Business Mailing Address
First Line : 6140 S MEMORIAL DR
Second Line :
City : TULSA
State : OK
Zip : 74133-1933
Country : US
Telephone Number : 918-252-2020
Fax Number :
Provider Business Practice Location Address
First Line : 3615 SE KENTUCKY ST
Second Line :
City : BARTLESVILLE
State : OK
Zip : 74006-2324
Country : US
Telephone Number : 918-333-2020
Fax Number :
Authorized Official
Title or Position : OWNER
Name : RYAN PATRICK CONLEY
Credential :
Telephone Number : 918-252-2020
Provider Enumeration Date : 11/18/2020
Last Update Date : 11/18/2020

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