Provider Demographics
NPI:1194007583
Name:MOSES CONE PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:MOSES CONE PHYSICIAN SERVICES, INC
Other - Org Name:THE CLINIC AT WALMART BURLINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO / TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-832-8005
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:CONE HEALTH, ASB, SUITE 201
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-8005
Mailing Address - Fax:336-832-8272
Practice Address - Street 1:3141 GARDEN RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9786
Practice Address - Country:US
Practice Address - Phone:336-584-0108
Practice Address - Fax:336-584-8835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MOSES H CONE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-13
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty