Provider Demographics
NPI:1992922033
Name:CLAIRE TIBILETTI MD PA
Entity type:Organization
Organization Name:CLAIRE TIBILETTI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:
Authorized Official - First Name:FRANCENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN CMOM
Authorized Official - Phone:903-597-2508
Mailing Address - Street 1:1814 ROSELAND BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4234
Mailing Address - Country:US
Mailing Address - Phone:903-597-2508
Mailing Address - Fax:903-535-2914
Practice Address - Street 1:1814 ROSELAND BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4234
Practice Address - Country:US
Practice Address - Phone:903-597-2508
Practice Address - Fax:903-535-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3856208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDA5545OtherRAILROAD MEDICARE GROUP
TXP00063083OtherRAILROAD MEDICARE INDIVIDUAL
TX0037KVOtherBLUE CROSS BLUE SHIELD
TX162224301Medicaid
TXDA5545OtherRAILROAD MEDICARE GROUP
TX00893VMedicare PIN
TXP00063083OtherRAILROAD MEDICARE INDIVIDUAL