# TRIAD COMPLETE HEALTHCARE A12 LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891506960
- **Authorized official:** MATTHEW BINTZ (CEO)
- **Authorized official phone:** (970) 270-7929

## Contact information

- **Practice address:** 908 N ROCKFORD RD STE A, ARDMORE, OK 73401-2541
- **Practice address phone:** (580) 251-7104
- **Mailing address:** 2703 N 14TH ST, PONCA CITY, OK 74601-1738
- **Mailing address phone:** (580) 749-7846

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/16/2025
- **Last updated:** 07/08/2026