Healthcare Provider Details

I. General information

NPI: 1659673838
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM STREET MOSES CONE HEALTH SYSTEM, ADMINISTRATIVESERVICES,STE201
GREENSBORO NC
27401-1020
US

IV. Provider business mailing address

1200 N ELM STREET MOSES CONE HEALTH SYSTEM, ADMINISTRATIVESERVICES,STE201
GREENSBORO NC
27401-1020
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-9943
  • Fax: 336-832-8272
Mailing address:
  • Phone: 336-832-9943
  • Fax: 336-832-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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