1467742767 NPI number — MOSES CONE AFFILIATED PHYSICIANS, INC

Table of content: (NPI 1467742767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467742767 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:
Provider Other Organization Name Type Code:
6
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:
1467742767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3931 TINSLEY DRIVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27265-1533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-282-8787
Provider Business Mailing Address Fax Number:
336-510-7284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 NORTH ELM STREET
Provider Second Line Business Practice Location Address:
ADMINISTRATIVE SERVICES SUITE 201
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27401-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-832-9943
Provider Business Practice Location Address Fax Number:
336-832-8272
Provider Enumeration Date:
04/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BOGGS
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
CFO AND TREASURER
Authorized Official Telephone Number:
336-832-8005

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5917059 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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