1891008207 NPI number — MOSES CONE AFFILIATED PHYSICIANS, INC.

Table of content: (NPI 1891008207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891008207 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:
1891008207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 NORTH ELM STREET
Provider Second Line Business Mailing Address:
MOSES CONE HEALTH SYSTEM-ADMINISTRATIVE SVC. STE. 201
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27401-1020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-832-8005
Provider Business Mailing Address Fax Number:
336-832-8272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 NORTH ELM STREET
Provider Second Line Business Practice Location Address:
MOSES CONE HEALTH SYSTEM-ADMINISTRATIVE SVC, STE. 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:
336-832-8005
Provider Business Practice Location Address Fax Number:
336-832-8272
Provider Enumeration Date:
07/15/2010

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/TREASURER
Authorized Official Telephone Number:
336-832-8005

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RE0101X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5914946 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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