Basic Information
| Provider Information | |||||||||
| NPI: | 1659673838 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOSES CONE AFFILIATED PHYSICIANS, INC. | ||||||||
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| OtherOrganizationName: | PIEDMONT SENIOR CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N ELM STREET | ||||||||
| Address2: | MOSES CONE HEALTH SYSTEM, ADMINISTRATIVESERVICES,STE201 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368329943 | ||||||||
| FaxNumber: | 3368328272 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 N ELM STREET | ||||||||
| Address2: | MOSES CONE HEALTH SYSTEM, ADMINISTRATIVESERVICES,STE201 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368329943 | ||||||||
| FaxNumber: | 3368328272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2010 | ||||||||
| LastUpdateDate: | 11/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | BOGGS | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | K. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3368328005 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE MOSES H. CONE MEMORIAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.