Healthcare Provider Details

I. General information

NPI: 1417383837
Provider Name (Legal Business Name): MOSES CONE MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 E NC HIGHWAY 150
BROWNS SUMMIT NC
27214-9719
US

IV. Provider business mailing address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 336-656-9905
  • Fax: 336-656-5227
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JARED COOPER
Title or Position: DIRECTOR, CHMG OPERATIONS
Credential:
Phone: 336-663-5044