Provider Demographics
NPI:1598271306
Name:THE MOSES H. CONE MEMORIAL HOSPITAL OPERATING CORPORATION
Entity Type:Organization
Organization Name:THE MOSES H. CONE MEMORIAL HOSPITAL OPERATING CORPORATION
Other - Org Name:RENAISSANCE FAMILY MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KIELI
Authorized Official - Middle Name:ASHTON
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-663-5220
Mailing Address - Street 1:300 E WENDOVER AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1229
Mailing Address - Country:US
Mailing Address - Phone:336-663-5220
Mailing Address - Fax:336-663-5366
Practice Address - Street 1:2525C PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5357
Practice Address - Country:US
Practice Address - Phone:336-832-7711
Practice Address - Fax:336-832-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty