Healthcare Provider Details

I. General information

NPI: 1720351430
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W WENDOVER AVE
GREENSBORO NC
27408-8447
US

IV. Provider business mailing address

311 W WENDOVER AVE
GREENSBORO NC
27408-8447
US

V. Phone/Fax

Practice location:
  • Phone: 336-274-1200
  • Fax: 336-274-4154
Mailing address:
  • Phone: 336-274-1200
  • Fax: 336-274-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

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