Provider Demographics
NPI:1376584789
Name:TRIANGLE AREA NETWORK INC
Entity Type:Organization
Organization Name:TRIANGLE AREA NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-832-8338
Mailing Address - Street 1:1495 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1345
Mailing Address - Country:US
Mailing Address - Phone:409-832-8338
Mailing Address - Fax:
Practice Address - Street 1:1495 N 7TH ST
Practice Address - Street 2:STE 5
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1301
Practice Address - Country:US
Practice Address - Phone:409-832-3377
Practice Address - Fax:409-832-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QF0400X, 363LF0000X
TX207Q00000X, 363LF0000X, 363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0060PDOtherBCBS
TX1960627-01Medicaid
741944OtherMEDICARE PART A