Provider Demographics
NPI:1467742767
Name:MOSES CONE AFFILIATED PHYSICIANS, INC
Entity Type:Organization
Organization Name:MOSES CONE AFFILIATED PHYSICIANS, INC
Other - Org Name:GUILFORD FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO AND 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 1:3931 TINSLEY DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1533
Mailing Address - Country:US
Mailing Address - Phone:336-282-8787
Mailing Address - Fax:336-510-7284
Practice Address - Street 1:1200 NORTH ELM STREET
Practice Address - Street 2:ADMINISTRATIVE SERVICES SUITE 201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1020
Practice Address - Country:US
Practice Address - Phone:336-832-9943
Practice Address - Fax:336-832-8272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MOSES H. CONE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-08
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917059Medicaid
NC2347353KMedicare PIN
NC5917059Medicaid