NPIMap

Organization Active NPI

Triad Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Bartlesville, OK
National Provider Identifier
1205439650
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
TRIAD SURGERY CENTER LLC
Practice address
3615 SE Kentucky St
Bartlesville, OK 74006-2324
Phone
(918) 333-2020
NPI assigned
Nov 18, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ryan Patrick ConleyNPI 1417016312
Title
Owner
Phone
(918) 252-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

3615 SE Kentucky St
Bartlesville, OK 74006-2324

Mailing address

6140 S Memorial Dr
Tulsa, OK 74133-1933
Phone (918) 252-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190826003198 OK Part B Supplier - Ambulatory Surgical Center 3173838620 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grove, OK; Muskogee, OK; Tulsa, OK; Bartlesville, OK

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2248047Triad Surgery Center3615 SE Kentucky St, Bartlesville, OK 74006Certificate of waiverJan 10, 2028

National Provider Directory

National Provider Directory
Tax ID family
Triad Eye Institute6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3131 Military Blvd
Muskogee, OK 74401
Phone (918) 290-2300

6140 S Memorial Dr
Tulsa, OK 74133
Phone (918) 252-2020

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1205439650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 S MEMORIAL DR",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741331933",
            "telephone_number": "918-252-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 SE KENTUCKY ST",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740062324",
            "telephone_number": "918-333-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-18",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "CONLEY",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-252-2020"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlesville, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.