MEDICARE: THE MOSES H. CONE MEMORIAL HOSPITAL OPERATING CORPORATION

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	333600000X	Pharmacy
2	3336I0012X	Institutional Pharmacy	11157	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2133045	OTHER		PK

General Provider Information

NPI Number	:	1982973293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MOSES H. CONE MEMORIAL HOSPITAL OPERATING CORPORATION

Provider Business Mailing Address
First Line	:	2630 WILLARD DAIRY RD
Second Line	:	SUITE B
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8351
Country	:	US
Telephone Number	:	336-884-3838
Fax Number	:	336-884-3840

Provider Business Practice Location Address
First Line	:	2630 WILLARD DAIRY RD
Second Line	:	SUITE B
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8351
Country	:	US
Telephone Number	:	336-884-3838
Fax Number	:	336-884-3840

Authorized Official
Title or Position	:	SITE COORDINATOR/PIC
Name	:	KIM PORTIS
Credential	:	PHARM D
Telephone Number	:	336-884-3837

Provider Enumeration Date	:	12/16/2011
Last Update Date	:	05/07/2018

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Practice Location Address:

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HIGH POINT, NC
27265-8351

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Practice Fax: 336-884-3840

Directions to “THE MOSES H. CONE MEMORIAL HOSPITAL OPERATING CORPORATION ” Practice Location

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