Provider Demographics
NPI:1982973293
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:SITE COORDINATOR/PIC
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:336-884-3837
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC111573336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0418648Medicaid
2133045OtherPK