Provider Demographics
| NPI: | 1427095249 |
|---|---|
| Name: | MOSES CONE MEDICAL SERVICES, INC. |
| Entity type: | Organization |
| Organization Name: | MOSES CONE MEDICAL SERVICES, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR, CHMG OPERATIONS |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JARED |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | COOPER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 336-663-5044 |
| Mailing Address - Street 1: | PO BOX 745040 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ATLANTA |
| Mailing Address - State: | GA |
| Mailing Address - Zip Code: | 30374-5040 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 1200 N ELM ST |
| Practice Address - Street 2: | |
| Practice Address - City: | GREENSBORO |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 27401-1004 |
| 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: | 2006-06-01 |
| Last Update Date: | 2023-06-30 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NC | 0255Y | Other | BCBS NC |
| NC | 790276M | Medicaid | |
| NC | 5905606 | Medicaid | |
| NC | 5915502 | Medicaid | |
| NC | 5920192 | Medicaid | |
| NC | 6006674 | Medicaid | |
| NC | 5906842 | Medicaid | |
| NC | 5907994 | Medicaid | |
| NC | 5914924 | Medicaid | |
| NC | 89014N2 | Medicaid | |
| NC | 5904658 | Medicaid | |
| NC | 5911593 | Medicaid | |
| NC | 5911951 | Medicaid | |
| NC | 790276Y | Medicaid | |
| NC | 5912718 | Medicaid | |
| NC | 6006280 | Medicaid | |
| NC | 89013T8 | Medicaid | |
| NC | 89015PT | Medicaid | |
| NC | 8902765 | Medicaid | |
| NC | 890276P | Medicaid | |
| NC | 0255Y | Other | BCBS NC |
| NC | 5912007 | Medicaid | |
| NC | 5917549 | Medicaid | |
| NC | 5901292 | Medicaid | |
| NC | 5918751 | Medicaid | |
| NC | 790275L | Medicaid | |
| NC | 5901292 | Medicaid | |
| NC | 2351920 | Medicare ID - Type Unspecified | MEDICARE |
| NC | 89015PT | Medicaid |
