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General NPI Number Information
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NPI Number | 1386186369
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Entity Type | Organization
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Legal Business Name | GOLDEN TRIANGLE INTERVENTIONAL PAIN ASSOCIATES LLC
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 6025 METROPOLITAN DR STE 290
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City | BEAUMONT
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State | TX
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Zip | 77706-2409
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Country | US
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Telephone | 409-554-0545
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Fax | 409-554-0921
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Provider Business Mailing Address
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Address Line | 6025 METROPOLITAN DR STE 290
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City | BEAUMONT
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State | TX
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Zip | 77706-2409
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Country | US
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Telephone | 409-554-0545
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Fax | 409-554-0921
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Authorized Official
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Title or Position | OWNER
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Name | CRAIG CHARLESTON
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Credential | M.D.
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Telephone | 409-554-0545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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