Provider Demographics
NPI:1053386177
Name:WEMPE, NOAH
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:WEMPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5500
Mailing Address - Street 2:SUITE 3130
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 W ILLINOIS AVE
Practice Address - Street 2:SUITE 3130
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6407
Practice Address - Country:US
Practice Address - Phone:432-570-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL90082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J8511OtherSWMI BCBS IND PROV #
TX163186302Medicaid
TXI05314Medicare UPIN
TXP00152773Medicare ID - Type UnspecifiedSWMI RR MCARE IND PROV #
TX8B5927Medicare ID - Type UnspecifiedSWMI MCARE PROV #
TX163186302Medicaid