Healthcare Provider Details

I. General information

NPI: 1528339967
Provider Name (Legal Business Name): MOSES CONE AFFILIATED PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

1200 N ELM ST
GREENSBORO NC
27401-1004
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 TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

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