Healthcare Provider Details

I. General information

NPI: 1689934994
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 CROUSE LN
BURLINGTON NC
27215-8833
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 336-585-1212
  • Fax: 336-585-1112
Mailing address:
  • Phone: 336-832-9513
  • Fax: 336-832-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

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