Basic Information
Provider Information
NPI: 1609824788
EntityType: 2
ReplacementNPI:  
OrganizationName: FORSYTH MEMORIAL HOSPITAL, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: NOVANT INPATIENT CARE SPECIALISTS - FORSYTH
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2000 FRONTIS PLAZA BLVD STE 102
Address2: ATTN: FORSYTH MEDICAL GROUP
City: WINSTON SALEM
State: NC
PostalCode: 271035616
CountryCode: US
TelephoneNumber: 3367187080
FaxNumber: 3367189622
Practice Location
Address1: 3333 SILAS CREEK PKWY
Address2:  
City: WINSTON-SALEM
State: NC
PostalCode: 271033013
CountryCode: US
TelephoneNumber: 3367187080
FaxNumber: 3367189622
Other Information
ProviderEnumerationDate: 05/04/2006
LastUpdateDate: 09/04/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GRIER
AuthorizedOfficialFirstName: MICHELE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP OPERATIONS
AuthorizedOfficialTelephone: 3367187080
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: FORSYTH MEMORIAL HOSPITAL, INC
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
CA131501NCRAILROAD MEDICAREOTHER
334001NCPARTNERSOTHER
0151701NCBCBS-NCOTHER
590151705NC MEDICAID


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