Provider Demographics
NPI:1154403863
Name:GOLDEN TRIANGLE NEUROCARE LLP
Entity type:Organization
Organization Name:GOLDEN TRIANGLE NEUROCARE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-898-7800
Mailing Address - Street 1:2965 HARRISON ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702
Mailing Address - Country:US
Mailing Address - Phone:409-898-7800
Mailing Address - Fax:409-898-3295
Practice Address - Street 1:2965 HARRISON ST
Practice Address - Street 2:SUITE 111
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702
Practice Address - Country:US
Practice Address - Phone:409-898-7800
Practice Address - Fax:409-898-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148913001Medicaid
TX0024TMedicare ID - Type Unspecified