Provider Demographics
NPI:1609944065
Name:TRIANGLE HOSPITAL CARE GROUP
Entity Type:Organization
Organization Name:TRIANGLE HOSPITAL CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:JADA
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-351-2497
Mailing Address - Street 1:4890 LITTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-8700
Mailing Address - Country:US
Mailing Address - Phone:409-351-2497
Mailing Address - Fax:409-670-0007
Practice Address - Street 1:4890 LITTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-8700
Practice Address - Country:US
Practice Address - Phone:409-351-2497
Practice Address - Fax:409-670-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7112207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00417YMedicare ID - Type Unspecified