MEDICARE: MOSES CONE MEDICAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	F06162611	NC

General Provider Information

NPI Number	:	1851744627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSES CONE MEDICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	1581 YANCEYVILLE ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6958
Country	:	US
Telephone Number	:	336-275-6445
Fax Number	:	336-275-3012

Provider Business Practice Location Address
First Line	:	1581 YANCEYVILLE ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6958
Country	:	US
Telephone Number	:	336-275-6445
Fax Number	:	336-275-3012

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SALLY HAMMOND
Credential	:
Telephone Number	:	336-663-5007

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	01/22/2020

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