Provider Demographics
NPI:1891134086
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:MEDCENTER HIGH POINT OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-832-9500
Mailing Address - Street 1:2630 WILLARD DAIRY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8351
Mailing Address - Country:US
Mailing Address - Phone:336-884-3838
Mailing Address - Fax:336-884-3840
Practice Address - Street 1:2630 WILLARD DAIRY RD
Practice Address - Street 2:SUITE B
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8351
Practice Address - Country:US
Practice Address - Phone:336-884-3838
Practice Address - Fax:336-884-3840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-20
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11157332B00000X, 333600000X, 3336C0003X, 3336I0012X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3459573OtherNCPDP
NC6952750001Medicare NSC