| Triad Complete Healthcare A11, Llc | |
|
200 N Bryant Ave Ste 105 Edmond OK 73034-6273 | |
| (405) 300-8964 | |
| Not Available |
| Full Name | Triad Complete Healthcare A11, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 200 N Bryant Ave Ste 105, Edmond, Oklahoma |
| Authorized Official Name and Position | Amanda Bodine (OWNER/CEO) |
| Authorized Official Contact | 6364850731 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Triad Complete Healthcare A11, Llc 200 N Bryant Ave Ste 105 Edmond OK 73034-6273 Ph: () - | Triad Complete Healthcare A11, Llc 200 N Bryant Ave Ste 105 Edmond OK 73034-6273 Ph: (405) 300-8964 |
| NPI Number | 1770344160 |
|---|---|
| Provider Enumeration Date | 01/22/2024 |
| Last Update Date | 01/22/2024 |
| Medicare PECOS PAC ID | 4183064868 |
|---|---|
| Medicare Enrollment ID | O20240429000745 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770344160 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jeffrey Carter Melton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780823104 PECOS PAC ID: 9436206448 Enrollment ID: I20090408000670 |
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