Organization
TRIAD COMPLETE HEALTHCARE A12 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW BINTZ (CEO)
(970) 270-7929
Entity
Organization
Contact information
Practice address
2002 12TH AVE NW, ARDMORE, OK 73401-1227
(580) 251-7104
Mailing address
2703 N 14TH ST, PONCA CITY, OK 74601-1738
(580) 749-7846
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
01/16/2025
Last updated
03/25/2025
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