1538593850 NPI number — MOSES CONE AFFILIATED PHYSICIANS, INC.

Table of content: (NPI 1538593850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538593850 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:
ROCKINGHAM EYE ASSOCIATES, PA
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:
1538593850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 405633
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-5633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-563-3282
Provider Business Mailing Address Fax Number:
605-677-3301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 THOMPSON ST
Provider Second Line Business Practice Location Address:
SUITE A.
Provider Business Practice Location Address City Name:
EDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27288-5068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-627-5271
Provider Business Practice Location Address Fax Number:
336-623-5182
Provider Enumeration Date:
08/22/2013

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  26004 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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