Healthcare Provider Details

I. General information

NPI: 1255609038
Provider Name (Legal Business Name): MOSES CONE PHYSICIAN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST MOSES CONE HEALTH SYSTEN, ADMINISTRATIVE SVC, STE. 201
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

1200 N ELM ST MOSES CONE HEALTH SYSTEN, ADMINISTRATIVE SVC, STE. 201
GREENSBORO NC
27401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-9511
  • Fax:
Mailing address:
  • Phone: 336-832-9511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT LEE GOLDSTEIN
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 336-541-1746