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General NPI Number Information
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NPI Number | 1609944065
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Entity Type | Organization
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Legal Business Name | TRIANGLE HOSPITAL CARE GROUP
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4890 LITTLEWOOD DR
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City | BEAUMONT
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State | TX
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Zip | 77706-8700
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Country | US
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Telephone | 409-351-2497
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Fax | 409-670-0007
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Provider Business Mailing Address
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Address Line | 4890 LITTLEWOOD DR
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City | BEAUMONT
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State | TX
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Zip | 77706-8700
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Country | US
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Telephone | 409-351-2497
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Fax | 409-670-0007
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Authorized Official
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Title or Position | OWNER
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Name | VICTORIA JADA GORDON
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Credential | MD
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Telephone | 409-351-2497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | K7112
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License Number State | TX
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