MEDICARE: GOLDEN TRIANGLE CANCER CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0203X	Radiation Oncology Clinic/Center

General Provider Information

NPI Number	:	1639538655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN TRIANGLE CANCER CENTER LLC

Provider Business Mailing Address
First Line	:	2875 JIMMY JOHNSON BLVD
Second Line	:	SUITE 100
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2002
Country	:	US
Telephone Number	:	409-338-3007
Fax Number	:

Provider Business Practice Location Address
First Line	:	2875 JIMMY JOHNSON BLVD
Second Line	:	SUITE 100
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2002
Country	:	US
Telephone Number	:	409-338-3007
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. TRIPTESH K CHAUDHURY
Credential	:	MD
Telephone Number	:	409-338-3007

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/18/2016

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