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General NPI Number Information
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NPI Number | 1376584789
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Entity Type | Organization
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Legal Business Name | TRIANGLE AREA NETWORK INC
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 1495 N 7TH ST STE 5
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City | BEAUMONT
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State | TX
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Zip | 77702-1301
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Country | US
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Telephone | 409-832-3377
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Fax | 409-832-3349
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Provider Business Mailing Address
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Address Line | 1495 N 7TH ST
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City | BEAUMONT
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State | TX
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Zip | 77702-1345
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Country | US
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Telephone | 409-832-8338
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MS. AMANDA M GIBSON
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Credential |
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Telephone | 409-832-8338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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