Provider Demographics
NPI:1750135950
Name:GOLDEN TRIANGLE INTERNAL MEDICINE PA
Entity type:Organization
Organization Name:GOLDEN TRIANGLE INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:VPMM,CEO,CFO,COO
Authorized Official - Phone:409-347-3621
Mailing Address - Street 1:PO BOX 5328
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-5328
Mailing Address - Country:US
Mailing Address - Phone:409-347-3621
Mailing Address - Fax:409-860-9078
Practice Address - Street 1:3080 MILAM ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4828
Practice Address - Country:US
Practice Address - Phone:409-347-3621
Practice Address - Fax:409-860-9078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty