1295134948 NPI number — MOSES CONE PHYSICIAN SERVICES, INC

Table of content: (NPI 1295134948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295134948 NPI number — MOSES CONE PHYSICIAN SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOSES CONE PHYSICIAN SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALAMANCE VEIN AND VASCULAR SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295134948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 N ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27401-1004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-832-7764
Provider Business Mailing Address Fax Number:
336-832-8272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2977 CROUSE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27215-9480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-584-4200
Provider Business Practice Location Address Fax Number:
336-584-3616
Provider Enumeration Date:
08/19/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOLDSTEIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
EXECUTVIE VICE PRESIDENT
Authorized Official Telephone Number:
336-832-6250

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1295134948 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DP9052 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 02C36 . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".