Provider Demographics
NPI:1831500883
Name:NOBLE HEALTHCARE
Entity Type:Organization
Organization Name:NOBLE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:1702-458-1495
Mailing Address - Street 1:2389 RENAISSANCE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6106
Mailing Address - Country:US
Mailing Address - Phone:170-245-8149
Mailing Address - Fax:170-245-8786
Practice Address - Street 1:2389 RENAISSANCE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6106
Practice Address - Country:US
Practice Address - Phone:170-245-8149
Practice Address - Fax:170-245-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00793261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service