Healthcare Provider Details

I. General information

NPI: 1619244936
Provider Name (Legal Business Name): MOSES CONE PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 N ELM ST SUITE 300
GREENSBORO NC
27401-6309
US

IV. Provider business mailing address

1200 N ELM ST CONE HEALTH, ADMINISTRATIVE SERVICES, SUITE 201
GREENSBORO NC
27401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 336-271-3331
  • Fax: 336-271-3724
Mailing address:
  • Phone: 336-832-7764
  • Fax: 336-832-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

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