Provider Demographics
NPI:1609120757
Name:TRIANGLE CLINIC LLC
Entity Type:Organization
Organization Name:TRIANGLE CLINIC LLC
Other - Org Name:TRIANGLE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MT,ASCP
Authorized Official - Phone:409-724-1404
Mailing Address - Street 1:3128 SABA LN
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-5422
Mailing Address - Country:US
Mailing Address - Phone:409-724-1404
Mailing Address - Fax:409-724-0171
Practice Address - Street 1:3128 SABA LN
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5422
Practice Address - Country:US
Practice Address - Phone:409-724-1404
Practice Address - Fax:409-724-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-27
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care