Healthcare Provider Details

I. General information

NPI: 1891008207
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTH ELM STREET MOSES CONE HEALTH SYSTEM-ADMINISTRATIVE SVC, STE. 201
GREENSBORO NC
27401-1020
US

IV. Provider business mailing address

1200 NORTH ELM STREET MOSES CONE HEALTH SYSTEM-ADMINISTRATIVE SVC. STE. 201
GREENSBORO NC
27401-1020
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNC

VIII. Authorized Official

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