MEDICARE: MOSES CONE MEDICAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1417383837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSES CONE MEDICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	1200 N ELM ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-1004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 E NC HIGHWAY 150
Second Line	:
City	:	BROWNS SUMMIT
State	:	NC
Zip	:	27214-9719
Country	:	US
Telephone Number	:	336-656-9905
Fax Number	:	336-656-5227

Authorized Official
Title or Position	:	DIRECTOR, CHMG OPERATIONS
Name	:	JARED COOPER
Credential	:
Telephone Number	:	336-663-5044

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	06/14/2023

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