Basic Information
Provider Information
NPI: 1427095249
EntityType: 2
ReplacementNPI:  
OrganizationName: MOSES CONE MEDICAL SERVICES, INC.
LastName:  
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Mailing Information
Address1: PO BOX 405633
Address2:  
City: ATLANTA
State: GA
PostalCode: 303845633
CountryCode: US
TelephoneNumber: 3368329943
FaxNumber: 3368328272
Practice Location
Address1: 1200 N ELM ST
Address2:  
City: GREENSBORO
State: NC
PostalCode: 274011004
CountryCode: US
TelephoneNumber: 3368329943
FaxNumber: 3368328272
Other Information
ProviderEnumerationDate: 06/01/2006
LastUpdateDate: 11/27/2012
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: GOLDSTEIN
AuthorizedOfficialFirstName: ROBERT
AuthorizedOfficialMiddleName: L.
AuthorizedOfficialTitleorPosition: EXECUTIVE VICE PRESIDENT
AuthorizedOfficialTelephone: 3368326250
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: THE MOSES H. CONE MEMORIAL HOSPITAL
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 
207RC0000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RG0100X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
207RP1001X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
208000000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatrics 
208M00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansHospitalist 
207RC0001X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
207RE0101X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
207RI0011X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
103TC0700X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersPsychologistClinical
1041C0700X  N193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersSocial WorkerClinical
363A00000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363L00000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LA2100X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
207R00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
790255Y05NC MEDICAID
790276M05NC MEDICAID
590560605NC MEDICAID
591550205NC MEDICAID
592019205NC MEDICAID
600667405NC MEDICAID
590684205NC MEDICAID
590799405NC MEDICAID
591492405NC MEDICAID
89014N205NC MEDICAID
590465805NC MEDICAID
591159305NC MEDICAID
591195105NC MEDICAID
790276Y05NC MEDICAID
591271805NC MEDICAID
600628005NC MEDICAID
89013T805NC MEDICAID
89015PT05NC MEDICAID
890276505NC MEDICAID
890276P05NC MEDICAID
0255Y01NCBCBS NCOTHER
591200705NC MEDICAID
591754905NC MEDICAID
590129205NC MEDICAID
591875105NC MEDICAID
790275L05NC MEDICAID


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