Provider Demographics
NPI:1144645995
Name:NOBLE PAIN MANAGEMENT AND SPORTS MEDICINE PLLC
Entity type:Organization
Organization Name:NOBLE PAIN MANAGEMENT AND SPORTS MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-518-1112
Mailing Address - Street 1:431 E STATE HIGHWAY 114 STE 120
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4416
Mailing Address - Country:US
Mailing Address - Phone:817-518-1112
Mailing Address - Fax:817-518-1113
Practice Address - Street 1:431 E STATE HIGHWAY 114 STE 120
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4416
Practice Address - Country:US
Practice Address - Phone:817-518-1112
Practice Address - Fax:817-518-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty