Provider Demographics
NPI:1174016711
Name:MOSES CONE PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:MOSES CONE PHYSICIAN SERVICES, INC.
Other - Org Name:FAMILY TREE OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTIONS, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-663-5007
Mailing Address - Street 1:520 MAPLE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-4600
Mailing Address - Country:US
Mailing Address - Phone:336-342-6063
Mailing Address - Fax:336-342-7847
Practice Address - Street 1:520 MAPLE AVE STE C
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-4600
Practice Address - Country:US
Practice Address - Phone:336-342-6063
Practice Address - Fax:336-342-7847
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MOSES H. CONE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty