Basic Information
Provider Information
NPI: 1336564863
EntityType: 2
ReplacementNPI:  
OrganizationName: THE MOSES H. CONE MEMORIAL HOSPITAL OPERATING CORPORATION
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: CONE HEALTH CENTER FOR CHILDREN
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 405633
Address2:  
City: ATLANTA
State: GA
PostalCode: 303845633
CountryCode: US
TelephoneNumber: 3368323150
FaxNumber: 3368323151
Practice Location
Address1: 301 E WENDOVER AVE
Address2: SUITE 400
City: GREENSBORO
State: NC
PostalCode: 274011230
CountryCode: US
TelephoneNumber: 3368323150
FaxNumber: 3368323151
Other Information
ProviderEnumerationDate: 02/20/2014
LastUpdateDate: 02/20/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: RICE
AuthorizedOfficialFirstName: ROBERT
AuthorizedOfficialMiddleName: TIMOTHY
AuthorizedOfficialTitleorPosition: CEO / PRESIDENT
AuthorizedOfficialTelephone: 3368329500
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: THE MOSES H. CONE MEMORIAL HOSPITAL
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080A0000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
2080P0006X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsDevelopmental – Behavioral Pediatrics
2080P0008X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
2080P0201X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
2080P0202X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
2080P0205X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
2080P0208X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
363A00000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363L00000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LF0000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LP0200X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
208000000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


Home