Provider Demographics
NPI:1386186369
Name:GOLDEN TRIANGLE INTERVENTIONAL PAIN ASSOCIATES LLC
Entity Type:Organization
Organization Name:GOLDEN TRIANGLE INTERVENTIONAL PAIN ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-857-6751
Mailing Address - Street 1:87 INTERSTATE 10 N
Mailing Address - Street 2:SUITE 221
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2544
Mailing Address - Country:US
Mailing Address - Phone:409-554-0545
Mailing Address - Fax:406-554-0921
Practice Address - Street 1:87 INTERSTATE 10 N
Practice Address - Street 2:SUITE 221
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2544
Practice Address - Country:US
Practice Address - Phone:409-554-0545
Practice Address - Fax:406-554-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty