Provider Demographics
NPI:1588751788
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:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MHA
Authorized Official - Phone:336-832-8108
Mailing Address - Street 1:301 E WENDOVER AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1230
Mailing Address - Country:US
Mailing Address - Phone:336-272-7255
Mailing Address - Fax:336-272-9615
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:STE 115
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-272-7255
Practice Address - Fax:336-272-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
NC072783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0417204Medicaid
2070638OtherPK