Healthcare Provider Details

I. General information

NPI: 1194744532
Provider Name (Legal Business Name): MOSES CONE MEDICAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N ELAM AVE
GREENSBORO NC
27403-1127
US

IV. Provider business mailing address

PO BOX 405633
ATLANTA GA
30384-5633
US

V. Phone/Fax

Practice location:
  • Phone: 336-547-1700
  • Fax:
Mailing address:
  • Phone: 336-547-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAS0052
License Number StateNC

VIII. Authorized Official

Name: MR. ROBERT LEE GOLDSTEIN
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 336-832-6250