| Triad Complete Healthcare A06 Llc | |
|
1411 W 12th Ave Ste E Stillwater OK 74074-5425 | |
| (405) 650-2110 | |
| (405) 372-2833 |
| Full Name | Triad Complete Healthcare A06 Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1411 W 12th Ave Ste E, Stillwater, Oklahoma |
| Authorized Official Name and Position | Stephen Chad Bayer (OWNER) |
| Authorized Official Contact | 4056502110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Triad Complete Healthcare A06 Llc 1220 W 12th Ave Stillwater OK 74074-4400 Ph: (405) 650-2110 | Triad Complete Healthcare A06 Llc 1411 W 12th Ave Ste E Stillwater OK 74074-5425 Ph: (405) 650-2110 |
| NPI Number | 1932809738 |
|---|---|
| Provider Enumeration Date | 03/09/2023 |
| Last Update Date | 10/23/2023 |
| Medicare PECOS PAC ID | 3274996590 |
|---|---|
| Medicare Enrollment ID | O20230901002493 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932809738 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Staci Rae Hawkins-pratt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760936033 PECOS PAC ID: 7113214255 Enrollment ID: I20170227001814 |
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