Basic Information
| Provider Information | |||||||||
| NPI: | 1013265909 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE MOSES H. CONE MEMORIAL HOSPITAL OPERATING CORPORATION | ||||||||
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| OtherOrganizationName: | CONE HEALTH SICKLE CELL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 405633 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303845633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883331348 | ||||||||
| FaxNumber: | 7083422517 | ||||||||
| Practice Location | |||||||||
| Address1: | 509-E NORTH ELAM AVENUE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274031129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368321970 | ||||||||
| FaxNumber: | 3368321988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2012 | ||||||||
| LastUpdateDate: | 10/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | KITZMILLER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | LAWRENCE | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 3368327579 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE MOSES H. CONE MEMORIAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5921312 | 05 | NC | MEDICAID |