NCC192397_Contact Update Record (Legally Resp Change)_20221109

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 11/9/2022 7:57:18 AM (Contact Changes Submitted)

Certificate of NCC192397
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2019-2397
Original NOI No.* 17274
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
The Moses H. Cone Memorial Hospital
Project Name Cone Health MedCenter
Address 3516 Drawbridge Pkwy, Greensboro, NC
County Guilford
Latitude 36.1397
Longitude-79.8662
Date COC Issued * 10/23/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
• BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? U No
Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Ronald Galloway
Individual (Previous)
First Name (New)* Anne
Last Name (New) * Macner

NEW Legally Reflects any revisions above
Responsible Anne Macner
Individual*
Permittee Email Ronald. Gal [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 1200 North Elm Street, 0, Greensboro, NC
Address (Previous) 27401
NEW Permittee Street Address
Mailing Address* 1200 North Elm Street
Address Line 2
City
State / Province / Region
Greensboro
NC
Postal / Zip Code
Country
27401
us
Permittee Street 1200 North Elm Street, 0, Greensboro, NC
Address (Previous) 27401
NEW Permittee Street Street Address
Address* 1200 North Elm Street
Address Line 2
City State / Province / Region
Greensboro NC
Postal / Zip Code Country
27401 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Ronald Galloway
(Previous)
Site Contact Title Director, Construction Management Department
(Previous)
Organization The Moses H. Cone Memorial Hospital
(Previous)
First Name (New)* Anne
Last Name (New) * Macner
NEW Site Contact* Reflects any revisions above
Anne Macner

NEW Site Contact Chief Administrative Officer
Title
NEW Organization The Moses H. Cone Memorial Hospital
This field is not required on the NOI form and may not pre -populate.
Site Contact Email Ronald. Gal [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 336-832-8502
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 1200 North Elm Street, 0, Greensboro, NC
Address (Previous) 27401
NEW Site Contact Street Address
Mailing Address* 1200 North Elm Street
Address Line 2
City
State / Province / Region
Greensboro
NC
Postal / Zip Code
Country
27401
us
Change Requested Anne Macner (Chief Administrative Officer) via Modification request submitted
by: * 11/1/2022. Ron Galloway has retired.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 11 /09/2022