| Noble Clinic, Llc | |
|
1322 S Broadway St Pittsburg KS 66762-5836 | |
| (620) 249-5443 | |
| Not Available |
| Full Name | Noble Clinic, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1322 S Broadway St, Pittsburg, Kansas |
| Authorized Official Name and Position | Michelle Coulter Morrell (OWNER) |
| Authorized Official Contact | 6202495443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Noble Clinic, Llc 1007 S Olive St Pittsburg KS 66762-5622 Ph: (620) 249-5443 | Noble Clinic, Llc 1322 S Broadway St Pittsburg KS 66762-5836 Ph: (620) 249-5443 |
| NPI Number | 1750810933 |
|---|---|
| Provider Enumeration Date | 06/09/2017 |
| Last Update Date | 08/14/2023 |
| Certification Date | 08/14/2023 |
| Medicare PECOS PAC ID | 9830463967 |
|---|---|
| Medicare Enrollment ID | O20170927003759 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750810933 | NPI | - | NPPES |
| 1104036110 | Other | NPI | |
| 12368901 | Other | CAQH | |
| 1447684931 | Other | KS | NPI |
| 1447684931 | Medicaid | KS | |
| 200442400D | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0759 (Kansas) | Primary |
| Provider Name | Cyndi Gayle Antoni |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710391248 PECOS PAC ID: 3375800568 Enrollment ID: I20171122002763 |
| Provider Name | Michelle L Coulter Morrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447684931 PECOS PAC ID: 6002151248 Enrollment ID: I20181217002551 |
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