Healthcare Provider Details

I. General information

NPI: 1194007583
Provider Name (Legal Business Name): MOSES CONE PHYSICIAN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 GARDEN RD
BURLINGTON NC
27215-9786
US

IV. Provider business mailing address

1200 N ELM ST CONE HEALTH, ASB, SUITE 201
GREENSBORO NC
27401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 336-584-0108
  • Fax: 336-584-8835
Mailing address:
  • Phone: 336-832-8005
  • Fax: 336-832-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH K BOGGS
Title or Position: CFO / TREASURER
Credential:
Phone: 336-832-8005