MEDICARE: MOSES CONE PHYSICIAN 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	:	1811424849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSES CONE PHYSICIAN 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	:	4620 WOODY MILL RD STE G
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-8779
Country	:	US
Telephone Number	:	336-907-3907
Fax Number	:	336-907-3910

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. SALLY PATRICIA HAMMOND
Credential	:
Telephone Number	:	336-663-5007

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	05/22/2017

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