Organization
TRIANGLE AREA NETWORK INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMANDA M GIBSON (COO)
(409) 832-8338
Entity
Organization
Contact information
Practice address
1495 N 7TH ST, STE 5, BEAUMONT, TX 77702-1301
(409) 832-3377
(409) 832-3349
Mailing address
1495 N 7TH ST, BEAUMONT, TX 77702-1345
(409) 832-8338
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
TX
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
TX
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060PD
BCBS
TX
05
—
1960627-01
—
TX
01
—
741944
MEDICARE PART A
—
Enumeration date
06/08/2006
Last updated
09/13/2022
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