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General NPI Number Information
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NPI Number | 1417467275
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Entity Type | Organization
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Legal Business Name | MOSES CONE PHYSICIAN SERVICES, INC.
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 2525C PHILLIPS AVE
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City | GREENSBORO
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State | NC
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Zip | 27405-5357
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Country | US
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Telephone | 336-832-7861
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 NORTH ELM STREET
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City | GREENSBORO
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State | NC
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Zip | 27401-1020
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | KIELI ASHTON FORBES
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Credential |
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Telephone | 336-832-7764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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