Provider Demographics
NPI:1255355723
Name:TRIAD MEDICAL INC
Entity type:Organization
Organization Name:TRIAD MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-363-5883
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:117 N MAIN
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-0854
Mailing Address - Country:US
Mailing Address - Phone:580-363-5883
Mailing Address - Fax:580-363-0409
Practice Address - Street 1:117 N MAIN
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-0854
Practice Address - Country:US
Practice Address - Phone:580-363-5883
Practice Address - Fax:580-363-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100795520AMedicaid
0262030001Medicare ID - Type Unspecified