Provider Demographics
NPI:1821385758
Name:MOSES CONE HEALTH SYSTEM
Entity Type:Organization
Organization Name:MOSES CONE HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-991-9394
Mailing Address - Street 1:3313 HORSE PEN CREEK RD
Mailing Address - Street 2:2H
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9813
Mailing Address - Country:US
Mailing Address - Phone:717-991-9394
Mailing Address - Fax:
Practice Address - Street 1:1125 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1007
Practice Address - Country:US
Practice Address - Phone:336-832-8035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital