1346474103 NPI number — MOSES CONE AFFILIATED PHYSICIANS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346474103 NPI number — MOSES CONE AFFILIATED PHYSICIANS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOSES CONE AFFILIATED PHYSICIANS, 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:
GREENSBORO GYNECOLOGY ASSOCIATES
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:
1346474103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
719 GREEN VALLEY RD STE 305
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:
27408-7026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-275-5391
Provider Business Mailing Address Fax Number:
336-275-4702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
719 GREEN VALLEY RD STE 305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27408-7026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-275-5391
Provider Business Practice Location Address Fax Number:
336-275-4702
Provider Enumeration Date:
05/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMOND
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
PATRICIA
Authorized Official Title or Position:
EXECUTIVE DIRECTOR, CHMG OPERATIONS
Authorized Official Telephone Number:
336-663-5007

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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