Healthcare Provider Details

I. General information

NPI: 1386186369
Provider Name (Legal Business Name): GOLDEN TRIANGLE INTERVENTIONAL PAIN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 METROPOLITAN DR STE 290
BEAUMONT TX
77706-2409
US

IV. Provider business mailing address

6025 METROPOLITAN DR STE 290
BEAUMONT TX
77706-2409
US

V. Phone/Fax

Practice location:
  • Phone: 409-554-0545
  • Fax: 409-554-0921
Mailing address:
  • Phone: 409-554-0545
  • Fax: 409-554-0921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CRAIG CHARLESTON
Title or Position: OWNER
Credential: M.D.
Phone: 409-554-0545