Provider Demographics
NPI:1699569624
Name:TRIAD COMPLETE HEALTHCARE Z15 LLC
Entity type:Organization
Organization Name:TRIAD COMPLETE HEALTHCARE Z15 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-270-7929
Mailing Address - Street 1:2703 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1738
Mailing Address - Country:US
Mailing Address - Phone:580-749-7846
Mailing Address - Fax:
Practice Address - Street 1:2703 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1738
Practice Address - Country:US
Practice Address - Phone:580-749-7846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty