Provider Demographics
NPI:1699086165
Name:NOBLE CARE PRIMARY CARE CENTER
Entity type:Organization
Organization Name:NOBLE CARE PRIMARY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:KINAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-563-7100
Mailing Address - Street 1:301 CASTLE SHANNON BLVD.
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234
Mailing Address - Country:US
Mailing Address - Phone:412-563-7100
Mailing Address - Fax:412-563-6915
Practice Address - Street 1:301 CASTLE SHANNON BLVD.
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234
Practice Address - Country:US
Practice Address - Phone:412-563-7100
Practice Address - Fax:412-563-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434099207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023780930001Medicaid