Healthcare Provider Details

I. General information

NPI: 1295013670
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 GREEN VALLEY RD SUITE 101
GREENSBORO NC
27408-7014
US

IV. Provider business mailing address

719 GREEN VALLEY RD SUITE 101
GREENSBORO NC
27408-7014
US

V. Phone/Fax

Practice location:
  • Phone: 336-370-0277
  • Fax: 336-333-9757
Mailing address:
  • Phone: 336-370-0277
  • Fax: 336-333-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

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