Provider Demographics
NPI:1720175086
Name:GOLDEN TRIANGLE RADIATION ONCOLOGY PLLC
Entity Type:Organization
Organization Name:GOLDEN TRIANGLE RADIATION ONCOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-729-8088
Mailing Address - Street 1:DEPT 283 PO BOX 4869
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210
Mailing Address - Country:US
Mailing Address - Phone:409-729-8088
Mailing Address - Fax:409-729-8089
Practice Address - Street 1:8333 9TH AVE
Practice Address - Street 2:STE G
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8083
Practice Address - Country:US
Practice Address - Phone:409-729-8088
Practice Address - Fax:409-729-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155311701Medicaid
TX00338UMedicare PIN