Healthcare Provider Details

I. General information

NPI: 1295134948
Provider Name (Legal Business Name): MOSES CONE PHYSICIAN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2977 CROUSE LN
BURLINGTON NC
27215-9480
US

IV. Provider business mailing address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 336-584-4200
  • Fax: 336-584-3616
Mailing address:
  • Phone: 336-832-7764
  • Fax: 336-832-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LEE GOLDSTEIN
Title or Position: EXECUTVIE VICE PRESIDENT
Credential:
Phone: 336-832-6250